VERIFIED CONTENTAuthor: lek. Maciej Grymuza, a graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań.

The ste alth syndrome is a group of symptoms resulting from vertebrobasilar insufficiency, i.e. disturbances in blood circulation within the head and one of the upper limbs. The disease occurs in a few percent of the population and manifests itself, inter alia, with fainting, blurred vision and features of limb ischemia. It is worth finding out how this disease arises, what symptoms it can cause and what are the treatment methods.

Theft syndromeis a group of symptoms caused by the "stealing" of blood circulating within the skull by the arteries of the hand, it results from the failure of the so-called basal-spine system. In the vast majority of cases, the causes are atherosclerotic changes, very rarely abnormal structure of the ribs or vascular diseases.

It is estimated that about 55% of cases are asymptomatic, if symptoms appear, they may result from cerebral ischemia (tinnitus, visual disturbances and balance disorders) but also in the upper limb - the so-called claudication, i.e. pain during exercise.

A certain diagnosis can only be made on the basis of imaging examinations, the dominant technique is carotid doppler. Treatment can be started with pharmacological therapy, if the symptoms are not severe, in more advanced cases an endovascular or open surgery is performed. Such a procedure usually brings about a permanent cure and symptom relief.

Anatomy of the arteries supplying the head and hands

The aorta in its initial section shows 3 important vessels: the brachiocephalic trunk, the left common carotid artery and the left subclavian artery.

The brachiocephalic trunk is then divided into two vessels: the right subclavian artery and the right common carotid artery.

The subclavian arteries are the source of blood for the upper limbs, while the carotid arteries give up branches - the internal carotid, whose further branches supply the brain and form the so-called Willis arterial circle within the skull. Its existence is important because in the case of restriction of patency, pressure drop in one of the supplying arteries, this connection is ensured byconstant blood supply to all areas of the brain.

The Willis arterial circle also receives blood from the basal artery of the brain, which is an extension of the vertebral arteries. The last of these are branches extending further into the subclavian arteries. In this way (through smaller branches and the Willis circle), the carotid and subclavian arteries, and thus the blood circulation in the brain and upper limbs, are connected.

Theft syndrome - causes

This disease most often affects people with atherosclerosis. The process of cholesterol deposition in the walls of the arteries affects the entire body: the coronary arteries, leading to ischemic heart disease - coronary, arteries of the lower limbs leading to their ischemia and finally the subclavian arteries.

Steal syndrome occurs when an atherosclerotic plaque builds up in the initial section of the left subclavian artery before departure of the vertebral artery and causes the artery to close or narrow so that blood flow to the entire upper limb and vertebral artery is impaired. This causes a drop in blood pressure in the vessels in the limb, and the blood begins to flow in the opposite direction than under normal conditions, i.e. from the brain to the vertebral artery on the side of the stenosis.

The ste alth syndrome is based on the retrograde blood flow through the cerebral vessels: the Willis arterial circle is supplied by the carotid arteries, then blood from the arterial circle flows from the brain towards the subclavian artery, basilar and vertebral arteries to the distal subclavian artery, then swim to the upper limb.

Such blood flow causes a reduction in the amount of blood in the brain, which has a specific impact on the symptoms. Due to anatomical conditions - the departure of the subclavian artery from the brachiocephalic trunk, the steal syndrome is very rare on the right side.

In rare cases, the steal syndrome is not the result of cholesterol deposition, it can also result from aneurysms, inflammatory vascular diseases, and sometimes also after radiotherapy, or in people with an extra rib, the so-called cervical rib. In each of these cases, there is a narrowing and restriction of the flow in the subclavian artery.

Theft syndrome - risk factors

All factors contributing to atherosclerosis are also risk factors for the occurrence of the steal syndrome, so they are:

  • older age
  • male gender
  • hypertension
  • lipid disorders: increase in LDL cholesterol (the so-called bad cholesterol) and decrease HDL (good cholesterol)
  • diabetes
  • obesity
  • smoking
  • family history of cardiovascular disease

Subclavian theft syndrome - symptoms

The disease develops for many years without any complaints, the condition lasts until the blood flow in the brain and upper limb remains sufficient for the functioning of both of these organs. The symptoms of the steal syndrome result from ischemia of one of these organs and they intensify whenever more blood flow is needed, e.g. during exercise or raising a hand.

Ailments related to upper limb ischemia include:

  • chilling
  • sometimes pallor and sensory disturbances in the form of numbness, tingling in the hand
  • effort-related hand pain is less frequent

A group of ischemic disorders may also include abnormal growth of skin products: hair and nails. The neurological symptoms resulting from cerebral ischemia are much more dangerous, they mainly include:

  • dizziness
  • fainting
  • visual disturbance
  • slurred speech
  • tinnitus
  • nystagmus
  • memory impairment
  • disorientation
  • imbalance
  • speech disorder

Of course, all neurological symptoms can also indicate many other diseases, so before the diagnosis of theft syndrome is made, the necessary neurological diagnostics should be carried out. The severity of all ailments depends primarily on the severity of the disease and the activity of the sick person.

It is also worth knowing that the symptom of the steal syndrome may be weakness or lack of pulse on the radial artery of the diseased hand and lower pressure on this limb compared to the he althy one.

Symptoms such as fainting, speech, balance or vision disturbances may be symptoms of a stroke, so urgent medical attention is required. Similarly, in the event of sudden pain in the arm at rest or sensory disturbances, urgent medical attention is needed as this may be a result of total limb ischemia.

Ste alth Team: Additional Research

The basis for the diagnosis are imaging examinations: ultrasound Doppler of vertebral arteries (the mentioned flow reversal is observed), and if it does not allow for a reliable diagnosis, angiography, computed tomography and, exceptionally, magnetic resonance are used.

There are no laboratory tests to make a diagnosis.

Subclavian theft syndrome: treatment

The Ste alth Team is notit is an urgent condition and does not require immediate diagnosis and hospital treatment. In the case of its symptoms, basic diagnostics may be performed by a family doctor, and then the sick person may be referred to specialists to confirm the diagnosis, depending on the predominant symptoms: to a vascular surgeon or a neurologist.

Depending on the cause and advancement of the disease, conservative or invasive treatment is undertaken. If the steal syndrome is atherosclerotic in origin and is not very advanced, treatment should begin with lifestyle modifications: physical activity, diet, and quitting smoking. Then, consideration is given to administering drugs similar to those in the case of coronary artery disease:

  • statins, i.e. drugs that lower blood cholesterol
  • acetylsalicylic acid (aspirin)
  • clopidogrel - a drug that inhibits blood clotting
  • angiotensin converting enzyme inhibitors, also used in heart diseases.

It should also be remembered that it is necessary to properly treat diabetes when it coexists. Such a procedure can be effective and often allows to reduce the severity of symptoms.

In the case of high advancement - pain at rest or bothersome symptoms from the central nervous system, it is necessary to undertake surgical intervention. It involves the widening of the vessel, which is performed by endovascular or surgical methods, the treatment method depends on the anatomical conditions, the size of the lesion and accompanying diseases. In the case of minimally invasive procedures, stents are implanted - similar to the treatment of coronary heart disease.

If a decision is made to operate, it will either open the subclavian artery or create a stenosis bypass. In this group of patients whose theft syndrome is due to reasons other than atherosclerosis, the procedure is slightly different. If the cervical rib is present, it should be removed surgically or produced bypassing it.

If the theft syndrome is due to the presence of an aneurysm or radiotherapy - treatment is also surgical. Appropriate pharmacotherapy is necessary in people with inflammatory arterial diseases.

Bow. Maciej GrymuzaA graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań. He graduated from university with an over good result. Currently, he is a doctor in the field of cardiology and a doctoral student. He is particularly interested in invasive cardiology and implantable devices (stimulators).

Category:

Cardiology