Successful Endovascular Treatment of a Severe Calcified Right Subclavian Artery Lesion Causing Subclavian Steal Syndrome

Abstract

Objective: Subclavian steal syndrome (SSS) is a clinically significant condition caused by proximal subclavian artery stenosis, leading to retrograde vertebral artery flowandvertebrobasilar insufficiency. We aimed topresent asymptomatic case successfully treated with an endovascular approach. Materials and Methods: A 73-year-old male with a history of coronary artery disease presented with dizziness and imbalance during upper extremity exertion. Physical examination revealed a marked interarm systolic blood pressure difference(60mmHgvs.110mmHg). Results: Transthoracic echocardiography showed preserved left ventricular function. Computed tomography angiography demonstrated a heavily calcified, near-total occlusion of the right subclavian artery distal to the common carotid origin. Conventional angiography confirmed the lesion and absence of antegrade flow in the right vertebral artery. Selective digital subtraction angiography revealed retrograde flow from the left vertebral artery into the right vertebral artery, consistent with SSS. Endovascular treatment was performed via femoral access using balloon angioplasty followed by stent implantation. Restoration of antegrade vertebral flow and near-complete resolution of retrograde flow were achieved without complications. Inter arm blood pressure normalized post-procedure. At one-week follow-up, the patient reported significant symptomatic improvement. Discussion and Conclusion: Endovascular revascularization may represent a safe and effective treatment option in symptomatic SSS, even in the presence of severe calcification. Early recognition and appropriate intervention can lead to favorable clinical outcomes.

Keywords

• Subclavian artery stenosis
• subclavian steal syndrome
• endovascular treatment

Supporting Institution

The authors received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors would like to thank all healthcare personnel involved in the patient’s diagnosis, treatment, and follow-up.

Ethical Statement

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

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