Bilateral occlusion associated to steal phenomenon of internal carotid and left subclavian arteries: treatment by angioplasty and stenting.

OBJECTIVE: Treatment of subclavian artery occlusion is still a matter of controversy due to the short- and long-term complications and patency issues. We report an unusual case of combined occlusion of the proximal segment of the left subclavian artery and subclavian steal phenomenon associated with bilateral occlusion of the internal carotid arteries.

CASE DESCRIPTION: A 55-year-old male patient with previous history of myocardial infarction and hypertension presented with amblyopia and recurrent dizziness, mainly at work. Doppler fluxometry and digital subtraction angiography depicted proximal left subclavian artery occlusion and subclavian steal. Internal carotid arteries were occluded at the common carotid artery bifurcation. Percutaneous transluminal angioplasty and stenting (PTAS) were successfully performed by the left radial artery approach without complications. The patient had no recurrence of the symptoms, and the angiographic follow-up at 1 year showed good patency of the subclavian artery and normal flow through the left vertebral artery.

CONCLUSION: The planned approach for the case (PTAS) was performed without complications and evidence of restenosis in the angiography study at the completion of the first year of the treatment. The described strategy is safe and should be considered the first-choice procedure in the treatment of the subclavian occlusion.