Subclavian steal syndrome – presentation of a case report and diagnostic algorithm


  • Teodor Angelov UMHAT "Alexandrovska"; Medical university – Sofia
  • Teodora Chamova UMHAT "Alexandrovska"; Medical university – Sofia
  • Plamen Antimov UMHAT "Alexandrovska"; Medical university – Sofia
  • Svetlin Tsonev UMHAT "Alexandrovska"; Medical university – Sofia; University „Prof. Dr. Asen Zlatarov” - Burgas
  • Kiril Karamfilov UMHAT "Alexandrovska"; Medical university – Sofia
  • Ivailo Tournev UMHAT "Alexandrovska"; Medical university – Sofia; New Bulgarian University - Sofia, Bulgaria


Subclavian steal syndrome, doppler sonography, computed tomography angiography


Subclavian steal syndrome (SSS) is compensatory for highgrade stenosis or occlusion of the proximal (before the separation of the a. vertebralis) segment of the a. subclavia hemodynamic condition, in which a. subclavia receives blood supply from the vertebro-basilar system through retrograde blood flow along the ipsilateral a. vertebralis, thus bypassing the stenotic region and ensuring trophic of the ipsilateral limb. It is often asymptomatic, but could be clinically manifested by symptoms of vertebro-basilar insufficiency – dizziness, drop attacks, hearing loss, tinnitus, positional nystagmus and headache, as well as symptoms of hypoperfusion of the upper limb – tingling, trophic changes, change in blood pressure and pulse rate. Doppler sonography (DS) is useful as a screening method, but stenosis/occlusion must be confirmed with angiographic techniques (computed tomography angiography (CTA), digital subtraction angiography (DSA) and magnetic resonance angiography (MPA)). Various methods of endovascular surgery are used in therapeutic terms.
We present a 71-year-old female with one-year-old complaints of pain in the left arm and limited mobility in the left shoulder joint, followed by dizziness and staggering to the left when walking for the past three to four weeks. After taking a complete somatic and neurological status and performing DS and CTA, the patient was diagnosed with SSS.


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How to Cite

Angelov, T., Chamova, T., Antimov, P., Tsonev, S., Karamfilov, K., & Tournev, I. (2022). Subclavian steal syndrome – presentation of a case report and diagnostic algorithm. Bulgarian Neurology, 23(1), 32–38. Retrieved from