gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Surgical treatment of subclavian steal syndrome: Surgical indication and selection of procedures by 123I-IMP-SPECT imaging and 99mTc-HSA accumulation curve of upper extremities

Meeting Abstract

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  • T. Fujita - Department of Neurosurgery, Saiseikai Tyuwa Hospital, Sakurai, Japan
  • Y. Niki - Department of Neurosurgery, Saiseikai Tyuwa Hospital, Sakurai, Japan

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 057

DOI: 10.3205/12dgnc444, URN: urn:nbn:de:0183-12dgnc4445

Published: June 4, 2012

© 2012 Fujita et al.
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Outline

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Objective: Diverse operative procedures have been proposed for correction of subclavian steal phenomenon. However, there ware few reports discussing surgical indication and selection of procedures by studying hemodynamic parameters. The objective of this paper was to select desirable operative procedure in the respective patients with subclavian steal syndrome by evaluating hemodynamic state of both brain and upper extremity.

Methods: In addition to conventional angiography, the authors studied the cerebral blood flow by 123I-IMP-SPECT imaging (IMP-SPECT), and the blood flow in the upper extremities by 99mTc-HSA accumulation curve (Tc-HSA) about 21 patients with subclavian steal syndrome. Endovascular surgery (i.e subclavian artery stenting) was performed on 10 cases in which the subclavian steal was caused by severe stenosis but patent subclavian artery. When the subclavian steal was caused by occlusion of subclavian artery, transposition of vertebral artery to common carotid artery (VA-CC) was performed on 7 cases in which Tc-HSA demonstrated no evidence of decreased blood flow in the upper extremities, and common carotid-subclavian dacron graft bypass was performed on 3 cases in which Tc-HSA revealed the evidence of decreased blood flow in the upper extremities. And arch aorta-common carotid dacron graft bypass was performed for a patient with the right subclavian steal due to innominate artery occlusion.

Results: Although all patients presented distinct symptoms and signs of vertebrobasilar insufficiency, IMP-SPECT early image demonstrated no evident finding of decreased blood flow in the posterior circulation, however, in the delayed image 5 out of 11 patients revealed laterality of IMP uptake in cerebellar hemisphere. All of 6 patients presented ischemic symptoms of the upper extremities including arm claudication showes that Tc-HSA indicated decreased blood flow in the affected side of arm and forearm. Postoperatively symptoms ware eliminated and angiography showed normograde vertebral artery flow and disappeared subclavian steal phenomenon in all patients. Although the VA-CC is not aimed at revascularization of subclavian artery, no ischemic symptom had been developed postoperatively.

Conclusions: To decide surgical indication and selection of procedures for the subclavian steal syndrome, adding IMP-SPECT and Tc-HSA to conventional angiography was throught to be usueful.