Letter to the Editor
Subclavian steal syndrome: A forgotten aetiology of acute cerebral ischaemia
Síndrome del robo de la subclavia. Una causa olvidada de isquemia cerebral aguda
Read
4708
Timeswas read the article
1100
Total PDF
3608
Total HTML
Share statistics
array:25 [ "pii" => "S2173580820300316" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2017.07.011" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1116" "copyright" => "Sociedad Española de Neurología" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2020;35:65-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0213485317302785" "issn" => "02134853" "doi" => "10.1016/j.nrl.2017.07.018" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1116" "copyright" => "Sociedad Española de Neurología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2020;35:65-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 9267 "formatos" => array:3 [ "EPUB" => 70 "HTML" => 8022 "PDF" => 1175 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Síndrome del robo de la subclavia. Una causa olvidada de isquemia cerebral aguda" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "65" "paginaFinal" => "67" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Subclavian steal syndrome: A forgotten aetiology of acute cerebral ischaemia" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1159 "Ancho" => 2500 "Tamanyo" => 213046 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a) Angio-RNM aorta torácica con reconstrucciones; b) Angio-TAC torácico. Obstrucción total del tercio proximal de la arteria subclavia izquierda con evidencia de contraste del área postestenótica a través de la arteria vertebral izquierda.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Antón Vázquez, P. Armario García, S.M. García Sánchez, C. Martí Castillejos" "autores" => array:4 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Antón Vázquez" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Armario García" ] 2 => array:2 [ "nombre" => "S.M." "apellidos" => "García Sánchez" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Martí Castillejos" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173580820300316" "doi" => "10.1016/j.nrleng.2017.07.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580820300316?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485317302785?idApp=UINPBA00004N" "url" => "/02134853/0000003500000001/v1_202003180804/S0213485317302785/v1_202003180804/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2173580820300353" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2020.03.001" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1120" "copyright" => "Sociedad Española de Neurología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2020;35:67-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Posterior reversible leukoencephalopathy after cyanamide overdose" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "67" "paginaFinal" => "68" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Leucoencefalopatía posterior reversible tras sobredosis de carbimida" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1669 "Ancho" => 2500 "Tamanyo" => 417092 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">MRI study showing signs of reversible posterior leukoencephalopathy syndrome. Subcortical white matter hyperintensities are observed in both occipital lobes, with focal extension to the left parietal and frontal areas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Y. Peñasco, A. González-Castro, J.C. Rodríguez-Borregán, R. Sánchez-de la Torre, A. González-Suárez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Y." "apellidos" => "Peñasco" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "González-Castro" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Rodríguez-Borregán" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Sánchez-de la Torre" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "González-Suárez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485317302827" "doi" => "10.1016/j.nrl.2017.07.022" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485317302827?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580820300353?idApp=UINPBA00004N" "url" => "/21735808/0000003500000001/v1_202004040635/S2173580820300353/v1_202004040635/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2173580820300341" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2017.07.013" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1113" "copyright" => "Sociedad Española de Neurología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2020;35:64-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Benign opsoclonus myoclonus syndrome and prostate cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "64" "paginaFinal" => "65" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome <span class="elsevierStyleItalic">opsoclonus mioclonus</span> de evolución benigna y cáncer de próstata" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Cuenca Hernández, A. Esquivel Lopez, R. Gordo Mañas, D. Hípola González" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Cuenca Hernández" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Esquivel Lopez" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Gordo Mañas" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Hípola González" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S021348531730275X" "doi" => "10.1016/j.nrl.2017.07.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021348531730275X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580820300341?idApp=UINPBA00004N" "url" => "/21735808/0000003500000001/v1_202004040635/S2173580820300341/v1_202004040635/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Subclavian steal syndrome: A forgotten aetiology of acute cerebral ischaemia" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "65" "paginaFinal" => "67" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "V. Antón Vázquez, P. Armario García, S.M. García Sánchez, C. Martí Castillejos" "autores" => array:4 [ 0 => array:4 [ "nombre" => "V." "apellidos" => "Antón Vázquez" "email" => array:1 [ 0 => "vanesa.anton.v@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "P." "apellidos" => "Armario García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "S.M." "apellidos" => "García Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Martí Castillejos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Área de Riesgo Cardiovascular, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome del robo de la subclavia. Una causa olvidada de isquemia cerebral aguda" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1159 "Ancho" => 2500 "Tamanyo" => 213141 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) MRI angiography of the thoracic aorta rendering reconstructions and (b) chest MRI angiography showing complete obstruction of the proximal third of the left subclavian artery, with contrast uptake in the post-stenotic area through the left vertebral artery.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Subclavian steal syndrome refers to subclavian artery stenosis before the origin of the vertebral artery, mainly due to the appearance of atheromatous plaques, which causes a retrograde flow in the ipsilateral vertebral artery together with transient neurological symptoms secondary to ischaemia in the affected territory.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Its prevalence ranges from 0.6% to 6.4% in the general population.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> It is more frequent in men (ratio of 2:1), with the exception of cases secondary to Takayasu arteritis, in which women are more commonly affected. The left subclavian artery is more frequently involved, with a ratio of 4:1.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a 70-year-old man with a history of arterial hypertension controlled with calcium channel blockers, angiotensin II receptor blockers, and thiazide; and type 2 diabetes mellitus treated with oral anti-diabetic drugs. The patient was admitted to the neurology department due to symptoms of central vertigo and gait ataxia of 48<span class="elsevierStyleHsp" style=""></span>hours’ progression.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The physical examination revealed marked asymmetry when arterial blood pressure (BP) was measured simultaneously in both arms. The mean BP calculated from 3 measurements was 100/70<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg in the right arm and 148/97<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg in the left. Heart sounds were regular and no heart or carotid murmur was heard. The radial pulse was less easily felt in the left wrist than in the right. The neurological examination revealed vertical nystagmus, gait ataxia, and moderate dysarthria. During the targeted interview, the patient reported frequent left arm pain of several months’ progression.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A head CT scan revealed no signs of acute ischaemia; a brain MRI confirmed an acute vertebrobasilar stroke. A Doppler ultrasonography of the supra-aortic trunks showed a biphasic pattern in the left subclavian artery, compatible with subclavian steal syndrome (grade 2). Examination of the basilar artery through the transforaminal window revealed inverted flow at a depth of 80<span class="elsevierStyleHsp" style=""></span>mm in the left vertebral artery and reduced flow speed in both posterior cerebral arteries.</p><p id="par0030" class="elsevierStylePara elsevierViewall">An MRI-angiography revealed severe stenosis of approximately 5<span class="elsevierStyleHsp" style=""></span>mm in diameter in the left subclavian artery, proximal to the origin of the homolateral vertebral artery; images were suggestive of retrograde flow in the left vertebral artery, which was permeable in a contrast study. These findings are compatible with subclavian steal syndrome (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Considering a diagnosis of acute vertebrobasilar ischaemia secondary to subclavian steal syndrome, we opted for endovascular treatment, placing a stent in the left prevertebral subclavian artery. A subsequent angiography confirmed that flow was adequate and no complications were observed. A one-month follow-up Doppler ultrasonography of the supra-aortic trunks and BP measurement in both arms revealed a significant reduction in the BP asymmetry: mean BP was 135/77<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg in the right arm and 145/76<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg in the left. The patient presented no new neurological events and the systematic examination revealed minimal residual ataxia, no vertigo signs, and remission of the left arm pain.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The most frequent aetiology in subclavian steal syndrome is atherosclerosis, followed in order of frequency by vasculitis, temporal arteritis, and embryonic malformation of the aortic arch and supra-aortic trunks.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Stenosis of the subclavian artery provokes a compensatory increase in flow in the contralateral vessels (which is responsible for the presence of a retrograde flow from the vertebral artery) to ensure adequate blood supply and improve perfusion in the affected territory.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> Vertebrobasilar insufficiency is infrequent, except in the event of a lesion affecting the contralateral vertebral artery or innominate artery stenosis.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Only 5% of patients with subclavian steal syndrome develop neurological symptoms. Most patients present proximal stenosis of the subclavian artery, compromising circulation to the posterior cerebral artery territory, specifically the V4 segment, which supplies the brainstem and cerebellum. Clinical symptoms typically include vertigo, ataxia, dysarthria, syncope, diplopia, and monocular or binocular vision impairment.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Arterial occlusion only occurs distally in rare cases, with the predominant symptom being claudication of the affected limb. Physical examination reveals asymmetric radial pulses, with a difference in BP of ><span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg between arms; supraclavicular auscultation may reveal artery bruit, depending on the degree of stenosis.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">There are 4 types of subclavian steal syndrome, depending on ultrasound findings: type 1, proximal stenosis of the subclavian artery or brachiocephalic trunk; type 2, severe proximal stenosis of the subclavian artery; type 3, anterograde flow from the vertebral artery at rest; and type 4, anterograde flow from the subclavian artery.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Diagnosis of vertebral subclavian steal syndrome is initially established if flow inversion in the vertebral artery is observed in a Doppler ultrasound study in patients with clinical suspicion. The study should be completed with a CT scan, MRI angiography, and arteriographic study,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> in order to locate the lesion precisely and assess treatment options. If vertebral subclavian steal syndrome is suspected, we should rule out such other causes as arrhythmias, poorly controlled hypertension, or pacemaker malfunction.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Indications for revascularisation are presence of symptoms of vertebrobasilar ischaemia, or severe extracranial atherosclerotic disease. The aim of treatment is to restore anterograde flow in the vertebral artery in order to improve the cerebral hypoperfusion.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Endovascular treatment of the lesions to the prevertebral subclavian artery is the treatment of choice, presenting a high success rate, minimal complications, and a low mortality rate.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> This technique offers greater long-term permeability when revascularisation is indicated due to symptoms of vertebrobasilar ischaemia than when it is indicated due to upper limb ischaemia.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Follow-up with Doppler ultrasound is very important in patients undergoing endovascular therapy in order to ensure the permeability of the stent.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In addition to the invasive revascularisation treatment, we should not forget the importance of adequately controlling cardiovascular risk in these patients by closely monitoring and controlling BP, lipid profile, and anticoagulant treatment, given the reported association between coronary and peripheral artery disease.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Our case illustrates the challenge of diagnosing subclavian steal syndrome as the cause of acute brain ischaemia. We stress the importance of simultaneously measuring BP in both arms; this should be performed routinely in all hypertensive patients as it is essential in the early diagnosis of the disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Antón Vázquez V, Armario García P, García Sánchez SM, Martí Castillejos C. Síndrome del robo de la subclavia. Una causa olvidada de isquemia cerebral aguda. Neurología. 2020;35:65–67.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1159 "Ancho" => 2500 "Tamanyo" => 213141 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) MRI angiography of the thoracic aorta rendering reconstructions and (b) chest MRI angiography showing complete obstruction of the proximal third of the left subclavian artery, with contrast uptake in the post-stenotic area through the left vertebral artery.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subclavian steal syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.J. Potter" 1 => "D.S. Pinto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.113.006653" "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "2014" "volumen" => "129" "paginaInicial" => "2320" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24891625" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0070" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and impact of the subclavian steal syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Labropoulos" 1 => "P. Nandivada" 2 => "K. Bekelis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0b013e3181e3375a" "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2010" "volumen" => "252" "paginaInicial" => "166" "paginaFinal" => "170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20531004" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0075" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of subclavian steal syndrome with clinical correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Osiro" 1 => "A. Zurada" 2 => "J. Gielecki" 3 => "M.M. Shoja" 4 => "R.S. Tubbs" 5 => "M. Loukas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.12659/msm.882721" "Revista" => array:6 [ "tituloSerie" => "Med Sci Monit" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "RA57" "paginaFinal" => "RA63" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22534720" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0080" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subclavian artery stenosis: prevalence, risk factors, and association with cardiovascular diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Shadman" 1 => "M.H. Criqui" 2 => "W.P. Bundens" 3 => "A. Fronek" 4 => "J.O. Denenberg" 5 => "C.A. Gamst" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2004.04.044" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2004" "volumen" => "44" "paginaInicial" => "618" "paginaFinal" => "623" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15358030" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0085" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of a difference in sistolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.E. Clark" 1 => "S. Rod-Taylor" 2 => "C.A. Shore" 3 => "O.C. Ukoumunne" 4 => "L.L. Campbell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(11)61710-8" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2012" "volumen" => "379" "paginaInicial" => "905" "paginaFinal" => "914" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22293369" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0090" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Doppler diagnosis of partial vertebral-subclavian steals convertible to full steals with physiologic maneuvers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.S. Kotval" 1 => "C.H. Sateesh" 2 => "P.M. Shah" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Ultrasound Med" "fecha" => "1990" "volumen" => "9" "paginaInicial" => "207" "paginaFinal" => "213" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0095" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subclavian steal syndrome: diagnosis with perfusion metrics from contrast-enhanced MR angiographic bolus-timing examination – initial experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Wu" 1 => "J. Zhang" 2 => "C.J. Ladner" 3 => "J.S. Babb" 4 => "P.J. Lamparello" 5 => "G.A. Krinsky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2353040710" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2005" "volumen" => "235" "paginaInicial" => "927" "paginaFinal" => "933" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15845794" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0100" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento endovascular del síndrome del robo de la subclavia sintomático" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Pilo-De la Fuente" 1 => "J. Masjuán-Vallejo" 2 => "R. Toledano-Delgado" 3 => "F. Gilo-Arrojo" 4 => "N. García-Barragán" 5 => "J. Blázquez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "2006" "volumen" => "42" "paginaInicial" => "57" "paginaFinal" => "58" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16402327" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0105" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angioplasty and stenting versus carotid subclavian bypass for the treatment of isolated subclavian artery disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.F. AbuRahma" 1 => "M.C. Bates" 2 => "P.A. Stone" 3 => "B. Dyer" 4 => "L. Armistead" 5 => "L. Scott Dean" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/152660280701400515" "Revista" => array:6 [ "tituloSerie" => "J Endovasc Ther" "fecha" => "2007" "volumen" => "14" "paginaInicial" => "698" "paginaFinal" => "704" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17924737" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0110" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endovascular management versus surgery for proximal subclavian artery lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Linni" 1 => "A. Ugurluoglu" 2 => "N. Mader" 3 => "W. Hitzl" 4 => "H. Magometschnigg" 5 => "T.J. Hölzenbein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.avsg.2008.08.001" "Revista" => array:6 [ "tituloSerie" => "Ann Vasc Surg" "fecha" => "2008" "volumen" => "22" "paginaInicial" => "769" "paginaFinal" => "775" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18809284" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0115" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Results after balloon angioplasty or stenting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Sixt" 1 => "A. Rastan" 2 => "U. Schwarzwälder" 3 => "K. Bürgelin" 4 => "E. Noory" 5 => "T. Schwarz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ccd.21836" "Revista" => array:6 [ "tituloSerie" => "Catheter Cardiovasc Interv" "fecha" => "2009" "volumen" => "73" "paginaInicial" => "395" "paginaFinal" => "403" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19214979" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0120" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estenosis de arteria subclavia: importancia de medir la presión arterial en ambas extremidades y su asociación con el riesgo cardiovascular" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Miranda" 1 => "M.A. Zarca" 2 => "C. Mora" 3 => "M.D. Sánchez" 4 => "I. Ferreras" 5 => "F. Rivera" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Hipertenso Riesgo Vasc" "fecha" => "2014" "volumen" => "31" "paginaInicial" => "23" "paginaFinal" => "26" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003500000001/v1_202004040635/S2173580820300316/v1_202004040635/en/main.assets" "Apartado" => array:4 [ "identificador" => "9409" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003500000001/v1_202004040635/S2173580820300316/v1_202004040635/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580820300316?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 0 | 8 |
| 2024 October | 65 | 16 | 81 |
| 2024 September | 70 | 14 | 84 |
| 2024 August | 59 | 29 | 88 |
| 2024 July | 48 | 14 | 62 |
| 2024 June | 31 | 9 | 40 |
| 2024 May | 35 | 11 | 46 |
| 2024 April | 37 | 86 | 123 |
| 2024 March | 57 | 15 | 72 |
| 2024 February | 35 | 7 | 42 |
| 2024 January | 64 | 10 | 74 |
| 2023 December | 51 | 23 | 74 |
| 2023 November | 75 | 17 | 92 |
| 2023 October | 106 | 42 | 148 |
| 2023 September | 81 | 9 | 90 |
| 2023 August | 91 | 23 | 114 |
| 2023 July | 70 | 36 | 106 |
| 2023 June | 60 | 26 | 86 |
| 2023 May | 92 | 22 | 114 |
| 2023 April | 101 | 18 | 119 |
| 2023 March | 87 | 12 | 99 |
| 2023 February | 66 | 21 | 87 |
| 2023 January | 46 | 17 | 63 |
| 2022 December | 46 | 17 | 63 |
| 2022 November | 41 | 21 | 62 |
| 2022 October | 49 | 24 | 73 |
| 2022 September | 49 | 28 | 77 |
| 2022 August | 50 | 26 | 76 |
| 2022 July | 26 | 32 | 58 |
| 2022 June | 34 | 17 | 51 |
| 2022 May | 34 | 16 | 50 |
| 2022 April | 60 | 23 | 83 |
| 2022 March | 95 | 20 | 115 |
| 2022 February | 119 | 19 | 138 |
| 2022 January | 56 | 15 | 71 |
| 2021 December | 46 | 15 | 61 |
| 2021 November | 44 | 21 | 65 |
| 2021 October | 57 | 20 | 77 |
| 2021 September | 66 | 26 | 92 |
| 2021 August | 49 | 11 | 60 |
| 2021 July | 35 | 14 | 49 |
| 2021 June | 52 | 7 | 59 |
| 2021 May | 75 | 13 | 88 |
| 2021 April | 218 | 42 | 260 |
| 2021 March | 197 | 21 | 218 |
| 2021 February | 186 | 32 | 218 |
| 2021 January | 134 | 15 | 149 |
| 2020 December | 106 | 12 | 118 |
| 2020 November | 92 | 16 | 108 |
| 2020 October | 52 | 8 | 60 |
| 2020 September | 38 | 19 | 57 |
| 2020 August | 20 | 7 | 27 |
| 2020 July | 15 | 30 | 45 |
| 2020 June | 7 | 13 | 20 |
| 2020 May | 7 | 10 | 17 |
| 2020 April | 18 | 13 | 31 |
Show all
