Abstract
Although retrograde vertebral artery flow was described over 100 years ago, its relationship to symptoms remains unclear. We documented 43 patients who were found by duplex scanning to have reverse flow in the vertebral artery. Of this group, seven patients (16%) were found to have symptoms described as typical for the “subclavian steal” syndrome. Nearly one-third were asymptomatic. Of the remaining patients, 13 (30%) presented with nonhemispheric symptoms while nine (21%) had hemispheric symptoms. Nine patients had “to and fro” flow in the vertebral artery. This variant was not found in subclavian steal patients but correlated with nonhemispheric symptoms. During follow-up (mean: 19 months) none of the asymptomatic patients became symptomatic, and there were no strokes or stroke-related deaths. Surgical procedures which restored antegrade vertebral artery flow did not necessarily improve symptoms of posterior circulation ischemia. In some patients improvement in posterior circulation symptoms was noted following carotid endarterectomy. It is concluded that retrograde flow in the vertebral artery is, per se, a benign entity. Accurate selection of surgical candidates remains imprecise. It will require not only identification of vertebrobasilar disease but as yet undefined tests to assure symptoms are due to these stenoses.
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References
CONTORNI L. The true story of the “subclavian steal syndrome” or “Harrison Smyth's syndrome”.J Cardiovasc Surg 1973;14:408–417.
REIVICH M, HOLLING HE, ROBERTS B, et al. Reversal of blood flow through the vertebral artery and its effect on cerebral circulation.N Engl J Med 1961;265:878–885.
A new vascular syndrome—“the subclavian steal” (editorial).N Engl J Med 1961;265:912–913.
BERGUER R, HIGGINS R, NELSON R. Non-invasive diagnosis of reversal of vertebral artery flow.N Engl J Med 1980;302:1349–1351.
VON REUTERN GM, POURCELOT L. Cardiac cycledependent alternating flow in the vertebral arteries with subclavian artery stenoses.Stroke 1978;9:229–236.
BORNSTEIN NM, NORRIS JW. Subclavian steal: a harmless hemodynamic phenomenon?Lancet 1986;2:303–305.
HENNERICI M, KLEMM C, RAUTENBERG W. The subclavian steal phenomenon: a common vascular disorder with rare neurologic deficits.Neurology 1988;38:669–673.
WALKER PM, PALEY D, HARRIS KA, et al. What determines the symptoms associated with subclavian artery occlusive disease?J Vasc Surg 1985;2:154–157.
LORD RS, ADAR R, STEIN RL. Contribution of the Circle of Willis to the subclavian steal syndrome.Circulation 1969;40:871–877.
KLINGELHOFER J, CONRAD B, BENECKE R, et al. Transcranial Doppler ultrasonography of carotid-basilar collateral circulation in subclavian steal.Stroke 1988;19:1036–1042.
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Nicholls, S.C., Koutlas, T.C. & Strandness, D.E. Clinical significance of retrograde flow in the vertebral artery. Annals of Vascular Surgery 5, 331–336 (1991). https://doi.org/10.1007/BF02015293
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DOI: https://doi.org/10.1007/BF02015293