Atypical presentation of subclavian steal syndrome with left sided sensorineural deafness

Figures

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  Fig 1. A, Depiction of subclavian steal syndrome (SSS) as it presented in our patient, with blood flow drawn to the left subclavian artery (LSA) from the contralateral vertebral artery and basilar artery. B, Drawing showing flow of blood after the bypass procedure directly into the ipsilateral common carotid artery, through the bypass, and into the LSA.

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  Fig 2. Reversal of flow through the vertebral artery in the setting of thoracic endovascular aortic repair (TEVAR). The labyrinthine artery is illustrated as it comes off the anterior inferior cerebellar artery. Dotted lines at the basilar and vertebral arteries depict possible anatomic variations.

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  Fig 3. Intraoperative angiography demonstrating antegrade left subclavian artery (LSA) flow before stent deployment (A) and retrograde flow via the ipsilateral vertebral artery after stent deployment (B).

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  Fig 4. A, Computed tomography angiography (CTA) of the chest, abdomen, and pelvis after stent placement during thoracic endovascular aortic repair (TEVAR) demonstrating left subclavian artery (LSA) ostial coverage and bovine arch anatomy. B, CTA of chest, abdomen, and pelvis at 2 years of follow-up showing stable appearance of aortic endograft.

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  Fig 5. Intraoperative angiography demonstrating antegrade left vertebral artery flow after carotid artery to subclavian artery bypass.