The Subclavian Steel Syndrome (SSS) is an emergency condition resulting from subclavian artery stenosis causing reduction in arterial blood flow to the upper limb and posterior circulation of the brain.
A case of a 46 years old woman with underlying Diabetes Mellitus, Hypertension and Dyslipidemia; presented with giddiness, vomiting prior admission associated with left upper limb pain and numbness for a week. She appeared conscious but tachycardia with increased systolic blood pressure. On examinations, noted positive cerebellar signs and acute left upper limb ischemia. Computerized Topography (CT) of Brain showed left cerebellar (PICA) territory acute infarct. While CT Angiography has shown left proximal subclavian artery thrombosis with significant occlusion/stenosis more than 50%. Subsequently, intravenous Heparin 80unit/kg was started. Case was further referred to Cardiothoracic and Vascular Team; opted for medical therapy. She has shown slight clinical improvement and was discharged with Warfarin and outpatient follow-up.
Discussion & Conclusion
SSS is frequently asymptomatic; and most common presentation is upper limb claudication associated with vertebrobasillar insufficiency (VBI) due to retrograde blood flow in vertebral artery. Surgical interventional therapy is indicated to restore anterograde blood flow in vertebral artery. If the occlusion at proximal subclavian artery, anti-platelet therapy use to reduce risk of Myocardial Infarction (MI), stroke and vascular causes of death. Early diagnosis and therapy of SSS can prevent the vascular cause of death. However, no medical therapy is known to be capable in treating SSS.
Subclavian Steel Syndrome