Vascular Ultrasonography Analysis of the Steal Phenomena Following Common Carotid Artery Obstruction

Introduction

High-grade stenotic or occlusive diseases of the common carotid artery (CCA) are not rare in clinical practice and can be seen in diverse cardiovascular diseases, including atherosclerosis, vasculitis, thrombosis, dissection etc. Collateral circulation often forms secondary to these obstructive lesions to maintain cerebral perfusion. Herein, we describe and analyze nine patients ([Table 1]) with a rare hemodynamic phenomenon “CCA steal”, resulting from severe obstructive diseases of the CCA, or both the right CCA and innominate artery (INA).

Table 1 General patient information, clinical manifestations and corresponding types of CCA steal.

patient	gender	age, y	diagnosis	history	symptoms	clinical sign	clinical stages of TA		type of CCA steal
							initial workup	follow-up
1	M	55	AS with TH	1–6 m	transient dizziness, intermittently transient motor weakness of the right upper and lower extremities	no obvious sign	–	–	complete
2	F	41	TA	> 20 yrs	dizziness, vertigo, weakness and claudication of the right upper extremities, carotodynia	pulse deficit at the right upper extremities	quiescent	quiescent/relapse	partial, transient complete
3	F	51	TA	> 2 yrs	transient dizziness, headache, weakness	hypertension	active	active/alleviation	partial, transient complete
4	F	42	TA	> 30 yrs	carotodynia, weakness and claudication of the left upper extremities	left cervical bruits, pulse deficit at the left upper extremities	quiescent	NF	partial, transient latent
5	F	40	TA	5 yrs	dizziness, weakness and claudication of the left upper extremities	pulse deficit at the left upper extremities	active	quiescent	partial, transient latent
6	F	32	TA	> 3 yrs	dizziness, weakness and claudication of the bilateral upper extremities	pulse deficit at the bilateral upper extremities	active	quiescent	latent
7	F	22	TA	6 yrs	dizziness, syncope, amaurosis fugax, jaw claudication, weakness and claudication of the right upper extremities	pulse deficit at the right upper extremities	active	quiescent	latent
8	F	60	TA	> 40 yrs	dizziness, vertigo, syncope, amaurosis fugax, jaw claudication, weakness and claudication of the bilateral upper extremities	pulse deficit at the bilateral upper extremities, bruit at the left cervical region	quiescent	quiescent, TH in AVs	latent
9	M	43	TA	> 18 yrs	dizziness, vertigo, arthralgia, weakness and claudication of bilateral upper extremities	pulse deficit at the bilateral upper extremities	quiescent	quiescent	latent

M: month; y: year-old; yrs: years; AS: atherosclerosis; TH: thrombosis; TA: Takayasu arteritis; –: not TA; NF: no follow-up; AVs: artificial vessels.