- Suspect subclavian steal syndrome in patients who headaches, dizziness, loss of consciousness (syncope), visual disturbances, loss of coordination, or facial numbness or pain, particularly during exercise of the arms.
diagnosis
Perform a physical exam, including:
- Blood pressure measurement in both arms, looking for a difference in systolic blood pressure ≥ 10-15 mm Hg between arms and assessing for an absent or delayed radial pulse
- Cardiac exam, listening for the presence of bruits over the supraclavicular region
- Skin exam and upper-extremity exam, looking for changes in skin color or temperature and other signs of peripheral artery disease
- Neurologic exam, looking for signs and symptoms of vertebrobasilar insufficiency, including ataxia, paresis, and paresthesia
Perform duplex ultrasound imaging to visualize reversal of blood flow within the vertebral artery to confirm diagnosis.
Consider magnetic resonance angiography (MRA) and computed tomography angiography (CTA) imaging in cases of diagnostic uncertainty or to determine the underlying pathology.
treatment
Stenting