Natural History/Late Neuro Events of Asymptomatic vs. Symptomatic Subclavian Steal as Detected by Duplex Ultrasound
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Charleston Area Medical Center, West Virginia
During Sunday’s Focused Symposium on Non-Invasive Vascular Diagnosis, vascular surgeon Ali F. AbuRahma, MD, medical director of the Vascular Laboratory and co-director of the Vascular Center of Excellence at Charleston Area Medical Center in West Virginia, presented on the topic of late neuro events of asymptomatic vs subclavian steal (SS) syndrome. SS is a condition characterized by the retrograde flow of blood in the vertebral artery due to subclavian artery stenosis or occlusion, and it has an unclear natural history.
Dr AbuRahma discussed his study, which is the largest study to date analyzing late neurological events (strokes and transient ischemic attacks) in patients with asymptomatic vs symptomatic isolated SS over a 5-year period. It analyzed 285 cases of SS detected via carotid duplex ultrasound examinations (CDUE) between January 1, 2017, and December 31, 2018. See slide below for demographics and clinical characteristics.
Late neurological events, including transient ischemic attacks (TIA) and strokes, were recorded for patients with isolated SS (without carotid disease). Kaplan-Meier analyses were conducted to assess freedom from stroke for different patient subgroups.
Of the study participants, 115 (40%) had isolated SS without associated carotid pathology; 85 were asymptomatic and 30 were symptomatic, exhibiting posterior circulation symptoms or arm claudication). Fifty-one interventions were performed in symptomatic patients, including subclavian percutaneous transluminal angioplasty (PTA) with stenting in 27 patients, carotid-subclavian bypasses (for claudication or posterior circulation symptoms) in 5 patients, and carotid endarterectomies (CEA) in 5 patients with associated carotid disease.
The study found that SS was rare, detected in just 2% (285/11,762) of patients undergoing CDUE; 191 cases (67%) had complete steal (retrograde vertebral flow), while 94 cases (33%) had partial steal (bidirectional flow). Sixty-four percent of cases were left-sided, and 33% were right-sided.
The mean follow-up was 34 months (range: 1-79 months), and 10 late strokes occurred in the entire study population. Among 115 patients with isolated SS, there was 1 TIA and 2 lates strokes in the asymptomatic group of 85 patients. Neither stroke was a posterior circulation event, with 1 lacunar hypertensive stroke and 1 cardiac embolism-related stroke. No late strokes were recorded in the symptomatic group of 30 patients.
