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Case Reports
Symptomatic obstruction of the brachiocephalic and left subclavian arteries obscured by aortic stenosis.
- Peter W Hashim, Roland Assi, Loreta Grecu, and Alan Dardik.
- Department of Surgery, Yale University School of Medicine, New Haven, CT.
- Ann Vasc Surg. 2014 Apr 1;28(3):737.e1-5.
AbstractStenosis or occlusion of the brachiocephalic artery represents an uncommon cause of cerebrovascular insufficiency. We report a patient with combined brachiocephalic and left subclavian obstruction with clinical manifestations of lightheadedness, syncope, and left-sided weakness who remained misdiagnosed essentially because of symmetrical pressures in the upper extremities. Aortic valve replacement for aortic stenosis failed to provide symptomatic relief. Eventual stenting of the brachiocephalic trunk resolved the patient's symptoms. Our report highlights the diagnostic challenges in this case of bilateral supraaortic vessel disease and shows that equal upper extremity pressures do not rule out brachiocephalic artery obstruction.Published by Elsevier Inc.
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