Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Class Summary

Antiplatelet agents inhibit platelet aggregation and reduce ischemic events. Patients should be treated with lifelong antiplatelet therapy to reduce the risk of associated myocardial infarction, stroke, and other vascular causes of death, if the cause of subclavian steal syndrome is determined to be atherosclerotic stenosis or occlusion of the proximal subclavian artery.

Aspirin (Bayer Aspirin, Ascriptin Maximum Strength, Ecotrin, Bufferin)

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Aspirin inhibits prostaglandin synthesis, which prevents the formation of platelet-aggregating thromboxane A2.

Clopidogrel (Plavix)

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Clopidogrel selectively inhibits adenosine diphosphate (ADP) binding to platelet receptors and subsequent ADP-mediated activation of the glycoprotein (GP) IIb/IIIa complex, thereby inhibiting platelet aggregation.

Ticlopidine

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Ticlopidine hydrochloride interferes with platelet membrane function by inhibiting adenosine diphosphate (ADP)–induced platelet-fibrinogen binding and subsequent platelet-platelet interaction. It is used as a second-line antiplatelet therapy for patients who are intolerant of aspirin therapy or in whom such therapy fails.

Questions

Sharma VK, Chuah B, Teoh HL, Chan BP, Sinha AK, Robless PA. Chronic brainstem ischemia in subclavian steal syndrome. J Clin Neurosci. 2010 Oct. 17 (10):1339-41. [QxMD MEDLINE Link].
Iared W, Mourão JE, Puchnick A, Soma F, Shigueoka DC. Angioplasty versus stenting for subclavian artery stenosis. Cochrane Database Syst Rev. 2022 Feb 21. 2 (2):CD008461. [QxMD MEDLINE Link].
Nicholls SC, Koutlas TC, Strandness DE. Clinical significance of retrograde flow in the vertebral artery. Ann Vasc Surg. 1991 Jul. 5 (4):331-6. [QxMD MEDLINE Link].
Labropoulos N, Nandivada P, Bekelis K. Prevalence and impact of the subclavian steal syndrome. Ann Surg. 2010 Jul. 252 (1):166-70. [QxMD MEDLINE Link].
Fields WS, Lemak NA. Joint Study of extracranial arterial occlusion. VII. Subclavian steal--a review of 168 cases. JAMA. 1972 Nov 27. 222 (9):1139-43. [QxMD MEDLINE Link].
Berguer R, Higgins R, Nelson R. Noninvasive diagnosis of reversal of vertebral-artery blood flow. N Engl J Med. 1980 Jun 12. 302 (24):1349-51. [QxMD MEDLINE Link].
Wrotniak L, Kabłak-Ziembicka A, Rosławiecka A, Musiałek P, Bogacki P, Trystuła M, et al. Resolution of ischemic symptoms after percutaneous angioplasty for a symptomatic subclavian artery stenosis. J Vasc Surg. 2016 Sep. 64 (3):684-91. [QxMD MEDLINE Link].
Potter BJ, Pinto DS. Subclavian steal syndrome. Circulation. 2014 Jun 3. 129 (22):2320-3. [QxMD MEDLINE Link].
Moghazy KM. Value of color Doppler sonography in the assessment of hemodialysis access dysfunction. Saudi J Kidney Dis Transpl. 2009 Jan. 20 (1):35-43. [QxMD MEDLINE Link].
Ziomek S, Quiñones-Baldrich WJ, Busuttil RW, Baker JD, Machleder HI, Moore WS. The superiority of synthetic arterial grafts over autologous veins in carotid-subclavian bypass. J Vasc Surg. 1986 Jan. 3 (1):140-5. [QxMD MEDLINE Link].
Benhammamia M, Mazzaccaro D, Ben Mrad M, Denguir R, Nano G. Endovascular and Surgical Management of Subclavian Artery Occlusive Disease: Early and Long-Term Outcomes. Ann Vasc Surg. 2020 Jul. 66:462-469. [QxMD MEDLINE Link].
Chatterjee S, Nerella N, Chakravarty S, Shani J. Angioplasty alone versus angioplasty and stenting for subclavian artery stenosis--a systematic review and meta-analysis. Am J Ther. 2013 Sep-Oct. 20 (5):520-3. [QxMD MEDLINE Link].
Song L, Zhang J, Li J, Gu Y, Yu H, Chen B, et al. Endovascular stenting vs. extrathoracic surgical bypass for symptomatic subclavian steal syndrome. J Endovasc Ther. 2012 Feb. 19 (1):44-51. [QxMD MEDLINE Link].
Satti SR, Golwala SN, Vance AZ, Tuerff SN. Subclavian steal: Endovascular treatment of total occlusions of the subclavian artery using a retrograde transradial subintimal approach. Interv Neuroradiol. 2016 Jun. 22 (3):340-8. [QxMD MEDLINE Link].
Karpenko A, Starodubtsev V, Ignatenko P, Gostev A. Endovascular Treatment of the Subclavian Artery Steno-Occlusive Disease. J Stroke Cerebrovasc Dis. 2017 Jan. 26 (1):87-93. [QxMD MEDLINE Link].

Media Gallery

Irregular proximal subclavian stenosis.
Retrograde blood flow from left vertebral artery into left subclavian artery in patient with subclavian steal syndrome.
Successful stent treatment of subclavian stenosis, with restored antegrade flow into vertebral artery.

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Author

Iman Bayat, MBBS, MRCS(Eng), FRACS(Vasc) Head of Vascular Surgery Unit, Department of Vascular Surgery, Northern Health, The Northern Hospital; Consultant Vascular and Endovascular Surgeon, Northern Health and Austin Health; Visiting Consultant Vascular Surgeon, Bendigo Health, Australia

Iman Bayat, MBBS, MRCS(Eng), FRACS(Vasc) is a member of the following medical societies: Royal Australasian College of Surgeons, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Coauthor(s)

Jason Chuen, MBBS, MPH, FRACS(Vasc), PGDipSurgAnat Vascular and Endovascular Surgeon, Director of Vascular Surgery, Director of 3D Medical Printing Laboratory, Austin Health; Clinical Associate Professor, Department of Surgery, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Australia

Jason Chuen, MBBS, MPH, FRACS(Vasc), PGDipSurgAnat is a member of the following medical societies: Academy of Surgical Educators, Association for Academic Surgery, Australasian Society for Ultrasound in Medicine, Australia and New Zealand Society of Phlebology, Australia and New Zealand Society of Vascular Surgery, Australian Chinese Medical Association of Victoria, Australian Medical Association, Melbourne Vascular Surgical Association, Royal Australasian College of Surgeons

Disclosure: Nothing to disclose.

Jonathan Fong, MBBS General Surgical Registrar, Austin Health

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD, FACS Professor and Chief, Division of Vascular and Endovascular Surgery, Gonda (Goldschmied) Vascular Center, University of California, Los Angeles, David Geffen School of Medicine

Vincent Lopez Rowe, MD, FACS is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Society of Black Academic Surgeons, Society of Black Vascular Surgeons, Southern California Vascular Surgical Society, Western Vascular Society

Disclosure: Nothing to disclose.

Acknowledgements

Jeffrey Lawrence Kaufman, MD Associate Professor, Department of Surgery, Division of Vascular Surgery, Tufts University School of Medicine

Jeffrey Lawrence Kaufman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society for Artificial Internal Organs, Association for Academic Surgery, Association for Surgical Education, Massachusetts Medical Society, Phi Beta Kappa, and Society for Vascular Surgery

Disclosure: Nothing to disclose.

Kenneth E McIntyre Jr, MD Professor of Surgery, Chief, Division of Vascular Surgery, University of Nevada School of Medicine; Chief, Surgical Service, Chief, Vascular Surgery, Veterans Administration of Southern Nevada

Kenneth E McIntyre Jr, MD is a member of the following medical societies: American College of Surgeons, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Southern Association for Vascular Surgery

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment