Resolution of Refractory Vertigo Following Endovascular Treatment of Right Subclavian Steal Syndrome

Subclavian steal syndrome (SSS) is characterized by retrograde blood flow in the vertebral artery caused by proximal stenosis or occlusion of the subclavian artery. Although SSS most often involves the left subclavian artery because it originates directly from the aortic arch, right-sided SSS is anatomically rare. This study reviews the current literature on the diagnostic challenges and therapeutic management of right-sided SSS, emphasizing the safety and efficacy of percutaneous transluminal angioplasty and stenting. Furthermore, we present an illustrative case of a 68-year-old male with medically refractory vertigo and right arm claudication. Clinical examination revealed a 40 mmHg inter-arm systolic blood pressure gradient. Angiography confirmed severe proximal right subclavian artery stenosis with retrograde steal. The patient was successfully treated with a balloon-expandable stent, resulting in complete anatomical resolution and immediate cessation of vertebrobasilar symptoms. Our clinical case underscores the necessity of routine bilateral blood pressure monitoring in patients with refractory vertigo and suggests that endovascular stenting appears to be a safe and effective, low-morbidity treatment strategy in such cases.