title: Right subclavian double steal syndrome: a case report.
abstract: BACKGROUND
  Double-steal syndrome represents a causative factor for blood flow compromise of the cerebral vascular bed with transient neurologic symptoms. We present the case of a patient with innominate artery atherosclerotic occlusion, manifested as blood flow reversal in the vertebral and common carotid arteries. Symptomatic atherosclerotic occlusive disease of the innominate artery is relatively rare and represents less than 2% of all extracranial causes of cerebrovascular insufficiency.
  
  
  METHODS
  We report on a 73-year-old male patient who presented at our hospital for the evaluation of dizziness and episodes of syncope. Angiography and color Doppler examinations documented the double syndrome as retrograde flow in the right vertebral artery and the right carotid artery.
  
  
  CONCLUSIONS
  Constituting an indication for surgical correction, his condition was managed with the performance of carotid-carotid extra-anatomic bypass for the permanent reestablishment of antegrade blood flow in the vascular network supplying the brain. Carotid-carotid extra-anatomic bypass was a good option for our patient, since he remains symptom free after one year of follow up.
authors.affiliation: Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece. kfilis@hotmail.com
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Filis
authors.forename: Levon
authors.initials: L
authors.lastname: Toufektzian
authors.forename: Frangiska
authors.initials: F
authors.lastname: Sigala
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kardoulas
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Kotzadimitriou
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lagoudianakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Koronakis
authors.forename: Andreas
authors.initials: A
authors.lastname: Manouras