title: Symptomatic obstruction of the brachiocephalic and left subclavian arteries obscured by aortic stenosis.
abstract: Stenosis 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.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hashim
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT; Interdepartmental Program in Vascular Biology and Therapeutics, Yale University School of Medicine, New Haven, CT.
authors.forename: Roland
authors.initials: R
authors.lastname: Assi
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT.
authors.forename: Loreta
authors.initials: L
authors.lastname: Grecu
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT; Interdepartmental Program in Vascular Biology and Therapeutics, Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven, CT. Electronic address: alan.dardik@yale.edu.
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D016122:Brachiocephalic Trunk / Q000503:physiopathology; D003251:Constriction, Pathologic; D003951:Diagnostic Errors; D004244:Dizziness / Q000209:etiology; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D018908:Muscle Weakness / Q000209:etiology; D011237:Predictive Value of Tests; D015607:Stents; D013349:Subclavian Steal Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D013575:Syncope / Q000209:etiology; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color