Prevalence and Clinical Characteristics of Subclavian Steal Phenomenon/Syndrome in Patients with Acute Ischemic Stroke

Abstract

There are no published clinical studies regarding the prevalence of subclavian steal among acute ischemic stroke patients. The aim of this study was to evaluate the prevalence and clinical significance of subclavian steal among a large number of consecutive ischemic stroke patients.

Materials and methods: We reviewed the medical records of 2192 consecutive cases of acute ischemic stroke at a tertiary neurology clinic in Targu Mures, Romania, between 2018 and 2020. In total, 47 patients (2.2%) were diagnosed with subclavian steal phenomenon/syndrome.

Results: Stroke patients with associated steal phenomenon were significantly younger (64.2 ± 11.1 versus 70.2 ± 12.8, p = 0.005) and predominantly male (68.1%). From among the 47 patients with subclavian steal phenomenon, nine (19.1%) presented stroke symptomatology in the vertebrobasilar territory. Overall, 83.3% of the stroke patients with associated steal phenomenon presented cerebral infarction and 16.7% presented TIA. There was no difference between groups regarding the affected vascular territory (VB versus carotid). Large artery atherosclerosis was more frequent in the stroke group with associated steal phenomenon (81.3% versus 43.5%, p = 0.0033). The NIHSS score at admission was higher in the patient group with associated steal phenomenon, but there was no difference in mRS at discharge. Associated carotid artery occlusion was more frequent in the stroke group with steal phenomenon (p < 0.01). Smoking and peripheral arteriopathy were more frequent in the patient group with associated steal phenomenon. Of the nine symptomatic patients, five underwent revascularization treatment.

Conclusions: The prevalence of subclavian steal phenomenon among acute ischemic stroke patients was not higher than in other cohorts with heterogenous peripheral vascular pathologies. Similar to the general population, in acute ischemic stroke patients, the associated subclavian steal behaved like a benign hemodynamical condition, without severe consequences.

Keywords: ischaemic stroke; subclavian steal phenomenon; subclavian steal syndrome.

Figure 1

Ultrasound examination of the cervical vessels. (a) B-mode; (b) color mode; (c) triplex mode ultrasound examination revealing a hypoechoic atherosclerotic plaque at the origin of the right subclavian artery leading to severe stenosis. (d–f) triplex mode examination of the right vertebral artery in basal conditions (d) during compression of the right arm (e) and reactive hyperemia (f) revealing negative midsysolic and no diastolic flow in basal conditions (d); the appearance of a minimal positive dyastolic flow during the compression of the arm ((e), arrow) and complete flow inversion during the entire cardiac cycle during reactive hyperemia of the arm (f); (g–i) ultrasound examination after balloon angioplasty of the right subclavian artery, revealing a significant reduction of the grade of stenosis. ((g) B-mode image, (h) triplex mode image, showing a normal triphasic subclavian waveform), and a normal, anterograd flow in the right vertebral artery (i). RCCA—right common carotid artery, RSCA—right subclavian artery, BRA—brachiocephalic artery, RVA—right vertebral artery.