Analysis of clinical characteristics of carotid steal syndrome

Objective To analyze the clinical and imaging characteristics in patients with carotid steal syndrome (CSS) and to investigate its compensatory pathways, diagnosis, and treatment. Methods The medical history and imaging data of the patients with CSS were collected. Their vascular lesions, collateral circulation, treatment, and prognosis were analyzed. Results A total of 11 patients with CSS (8 males and 3 females, mean age 66.7±5.1 years) were enrolled in the study. Their clinical manifestations were posterior circulation transient ischemic attack (TIA) (n=9, 81.8%), posterior circulation infarction (n=1, 9.1%), and anterior circulation TIA (n=1, 9.1%). A total of 19 pathological arteries were found: 12 (63.1%) with occlusion, 2 (10.5%) with subtotal occlusion, 4 (21.0%) with severe stenosis and 1 (5.2%) with artery dissection. Seven patients (63.6%) were bilateral internal carotid artery lesions, 3 (27.2%) were unilateral bilateral internal carotid artery lesions, and 1 (9.1%) was bilateral common carotid artery occlusion. Eleven patients had primary collateral circulation, including posterior communicating artery patency in 10 patients (90.9%) and anterior communicating artery patency in 1 patient (9.1%). Four patients (36.3%) had secondary collateral circulation and 1 (9.1%) had tertiary collateral circulation. All patients were treated with medication on the basis of the management of risk factors. Three patients were treated with stenting and two were treated with carotid endarterectomy. No stroke occurred in all patients during follow-up till September 2014. Conclusions The vascular lesions of patients with CSS often occur in the extracranial segment of internal carotid artery. Usually the compensatory blood is through the circle of Willis. The presentation is ischemia in the stolen arteries. Its diagnosis needs to be examined by digital subtraction angiography. On the basis of medication therapy, some patients may be treated with surgery or endovascular intervention. Key words: Carotid Steal Syndrome; Digital Subtraction Angiography; Collateral Circulation; Stents; Carotid Endarterectomy