Subclavian steal syndrome: Can the blood pressure difference between arms predict the severity of steal?

Teng Yeow Tan, U. L F Scsminke, Li Ming Lien, Charles H. Tegeler

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background and Purpose. A side-to-side difference in systolic brachial arterial blood pressure is a common finding in subclavian artery stenosis and is frequently used as a screening tool for subclavian steal syndrome (SSS). It was the goal of this retrospective study to investigate the relationship between different vertebral artery waveform types and the side-to-side difference in systolic blood pressure in patients with sonographically proven SSS. Methods. The records of 1860 patients from the Neuroultrasound Laboratory between January 2000 and December 2000 were screened for the diagnosis of SSS in the final ultrasound report. In all patients, bilateral brachial arterial blood pressure was measured in a sitting position prior to the ultrasound examination. Vertebral artery waveforms were classified as (1) systolic deceleration, (2) alternating flow, and (3) complete reversal at rest. Blood pressure difference as calculated by normal-side blood pressure minus lesion-side blood pressure was compared with the 3 Doppler waveform types. Results. SSS was found in 51 of 1860 (2.7%) ultrasonography studies of 49 patients (17 men, 32 women; mean age 65.3 ± 10.5 years). Two patients (4%) had bilateral SSS. In 3 patients (6%), SSS was related to an innominate artery stenosis. Waveform analysis showed a completely reversed flow in 16 (31%), an alternating flow in 24 (47%), and a systolic deceleration in 11 (22%) cases. Systolic blood pressure difference was significantly higher in the complete reversal and alternating groups than in the systolic deceleration group (P <.001). Conclusion. Brachial systolic blood pressure difference is related to the severity of SSS and can be used as a screening tool for SSS. However, it performed better in severe steal than milder steal phenomena.

Original languageEnglish
Pages (from-to)131-135
Number of pages5
JournalJournal of Neuroimaging
Volume12
Issue number2
Publication statusPublished - 2002
Externally publishedYes

Fingerprint

Subclavian Steal Syndrome
Blood Pressure
Deceleration
Arm
Vertebral Artery
Arterial Pressure
Brachiocephalic Trunk
Posture
Ultrasonography
Pathologic Constriction
Retrospective Studies

Keywords

  • Blood pressure difference
  • Subclavian steal syndrome
  • Vertebral artery waveform

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Neuroscience(all)
  • Radiological and Ultrasound Technology

Cite this

Subclavian steal syndrome : Can the blood pressure difference between arms predict the severity of steal? / Tan, Teng Yeow; Scsminke, U. L F; Lien, Li Ming; Tegeler, Charles H.

In: Journal of Neuroimaging, Vol. 12, No. 2, 2002, p. 131-135.

Research output: Contribution to journalArticle

Tan, Teng Yeow ; Scsminke, U. L F ; Lien, Li Ming ; Tegeler, Charles H. / Subclavian steal syndrome : Can the blood pressure difference between arms predict the severity of steal?. In: Journal of Neuroimaging. 2002 ; Vol. 12, No. 2. pp. 131-135.
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abstract = "Background and Purpose. A side-to-side difference in systolic brachial arterial blood pressure is a common finding in subclavian artery stenosis and is frequently used as a screening tool for subclavian steal syndrome (SSS). It was the goal of this retrospective study to investigate the relationship between different vertebral artery waveform types and the side-to-side difference in systolic blood pressure in patients with sonographically proven SSS. Methods. The records of 1860 patients from the Neuroultrasound Laboratory between January 2000 and December 2000 were screened for the diagnosis of SSS in the final ultrasound report. In all patients, bilateral brachial arterial blood pressure was measured in a sitting position prior to the ultrasound examination. Vertebral artery waveforms were classified as (1) systolic deceleration, (2) alternating flow, and (3) complete reversal at rest. Blood pressure difference as calculated by normal-side blood pressure minus lesion-side blood pressure was compared with the 3 Doppler waveform types. Results. SSS was found in 51 of 1860 (2.7{\%}) ultrasonography studies of 49 patients (17 men, 32 women; mean age 65.3 ± 10.5 years). Two patients (4{\%}) had bilateral SSS. In 3 patients (6{\%}), SSS was related to an innominate artery stenosis. Waveform analysis showed a completely reversed flow in 16 (31{\%}), an alternating flow in 24 (47{\%}), and a systolic deceleration in 11 (22{\%}) cases. Systolic blood pressure difference was significantly higher in the complete reversal and alternating groups than in the systolic deceleration group (P <.001). Conclusion. Brachial systolic blood pressure difference is related to the severity of SSS and can be used as a screening tool for SSS. However, it performed better in severe steal than milder steal phenomena.",
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