FEATURES OF FORMATION OF COLLATERAL CIRCULATION IN PATIENTS WITH SUBCLAVIAN STEAL SYNDROME

Area of Science:

• Vascular Surgery
• Neurology
• Cardiology

Background:

• Subclavian steal syndrome (SSS) diagnosis traditionally focuses on stenosis grade and occlusion site.
• Optimal treatment selection for SSS requires considering collateral cerebral circulation patterns.

Purpose of the Study:

• To investigate the formation and types of collateral circulation in patients diagnosed with SSS.
• To analyze the impact of different collateral mechanisms on SSS prognosis and treatment.

Main Methods:

• Analysis of blood flow direction in extracranial vessels of 42 SSS patients.
• Classification of SSS based on disease course: latent, transient, and persistent.
• Identification and categorization of extracranial and intracranial compensatory hemodynamic mechanisms.

Main Results:

• SSS presentations included latent (26.2%), transient (54.8%), and persistent (19.9%) forms.
• Vertebrobasilar insufficiency (VBI) symptoms were present in 26.6% of patients; 73.8% had combined chronic upper extremity ischemia and VBI.
• Extracranial collateral compensation (64.3%) involved occipito-vertebral (38.1%), thyroid (16.7%), and brain stem-occipital (9.5%) mechanisms.
• Intracranial collateral compensation (35.7%) included vertebro-vertebral (21.4%) and cerebrobasilar (14.3%) mechanisms.

Conclusions:

• Collateral circulation patterns in SSS are crucial prognostic indicators for treatment planning.
• The occipito-vertebral compensatory mechanism demonstrates the most beneficial effect on hemodynamic compensation in the vertebrobasilar basin.