経食道心エコー法により鎖骨下動脈盗血症候群を診断し得た１例

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  • A Case of Transesophageal Echocardiographic Identification of Subclavian Steal Syndrome

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Subclavian steal syndrome is a phenomenon arising from stenosis or obstruction of the subclavian artery proximal to the vertebral artery. Carotid ultrasonography has long been used for the identification of this phenomenon. However, the efficacy of transesophageal echocardiography (TEE) for the identification of subclavian steal syndrome has not been established. We present a case in which TEE was used for the identification of subclavian steal syndrome confirmed by angiography in a patient with transient ischemic attack. A 63-year-old man with a history of untreated hypertension was transferred for evaluation of transient right arm weakness. Neither brain CT nor MRI identified any acute ischemic lesion. A carotid ultrasound and cerebral angiographic examination revealed retrograde flow in the left vertebral artery, and subclavian steal syndrome was suspected. TEE was done to evaluate the left subclavian artery and to rule out any embolic source in the heart and aortic arch. TEE revealed occlusion of a long segment of the proximal left subclavian artery by isoechoic intramural plaque, and color/pulse wave Doppler examination of the proximal left vertebral artery revealed reversal of flow suggestive of steal syndrome. TEE represents an additional ultrasound approach for noninvasive assessment of subclavian steal syndrome.

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