Critical Left Subclavian Artery Stenosis With Retrograde Vertebral Flow: A Case Report and Literature Review

Subclavian artery stenosis is a rare condition associated with significant morbidity and mortality, making prompt recognition and treatment essential. We present a case of left-sided subclavian artery occlusion with neurological symptoms, including vertigo, unsteady gait, and left upper extremity pain and paresthesia. The patient's symptoms had been progressing over several months. Her risk factors included age, hyperlipidemia, and poorly controlled blood pressure with resultant arteriosclerosis throughout her vasculature. An arteriogram demonstrated critical stenosis of the left subclavian with retrograde flow through the left vertebral artery. Aspirin and clopidogrel were initiated prior to successful balloon angioplasty and stenting. After stent placement, the patient had minimal residual subclavian stenosis and anterograde vertebral artery flow. In this case report, we discuss clinical presentation, typical examination and imaging findings, and treatment options for subclavian stenosis including medical management and revascularization procedures.