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Recurrent syncope during mastication.

Otavio F De Toledo1,2, Salvador F Gutierrez-Aguirre1,2, Mateus R Alessi3

  • 1Lyerly Neurosurgery, Baptist Neurological Institute, 800 Prudential Dr Suite 1100, Jacksonville, FL 32207, United States.

Journal of Surgical Case Reports
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PubMed
Summary
This summary is machine-generated.

This case study details a rare double steal phenomenon causing cerebrovascular insufficiency. Successful endovascular stenting of the brachiocephalic trunk resolved the patient's neurological symptoms.

Keywords:
double steal syndromerecurrent syncopesteal syndrome

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Area of Science:

  • Vascular Surgery
  • Neurology
  • Interventional Cardiology

Background:

  • Steal syndrome involves blood flow diversion around arterial blockages.
  • Neurovascular steal syndromes, like subclavian steal, are often linked to atherosclerosis.
  • A rare double steal phenomenon presents unique diagnostic and therapeutic challenges.

Observation:

  • An early 80s patient experienced neurological deficits during mastication.
  • Angiography revealed occlusions in the left common carotid and brachiocephalic trunk origins.
  • This led to retrograde flow in the right vertebral artery and anterograde flow in the left vertebral artery.

Findings:

  • The patient presented with a complex arterial occlusion pattern causing a double steal phenomenon.
  • Endovascular revascularization of the brachiocephalic trunk was technically successful.
  • The intervention utilized a Gore Viabahn VBX Balloon Expandable Stent.

Implications:

  • Successful revascularization resolved the patient's mastication-related neurological symptoms.
  • This case highlights the importance of considering rare steal syndromes in cerebrovascular insufficiency.
  • Endovascular techniques offer a viable treatment option for complex double steal phenomena.