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Case Reports: Reminder of important clinical lesson
Headache may be the only symptom of subclavian steal syndrome after thoracic endovascular aortic repair
  1. Rajkumar Rajendram1,2 and
  2. Abdulaziz Abdullah Aldbas1
  1. 1College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Al Riyadh Province, Saudi Arabia
  2. 2Department of Medicine, King Abdulaziz Medical City, Riyadh, Al Riyadh Province, Saudi Arabia
  1. Correspondence to Dr Rajkumar Rajendram; rajkumarrajendram{at}doctors.org.uk

Abstract

Thoracic endovascular aortic repair (TEVAR) is currently the treatment of choice for thoracic aortic disease. In select cases, the TEVAR stent must occlude the left subclavian artery. This is usually well tolerated, but the subclavian steal syndrome (SCSS) may occur. Vertebrobasilar insufficiency can cause headaches, but reports of headache as the only symptom of SCSS are very rare. Thus, this may be under-recognised. To increase the awareness of this complication we describe the course of a patient who developed chronic intermittent headaches after intentional occlusion of the left subclavian artery with a TEVAR stent. Revascularisation may be required to prevent adverse neurological outcomes from SCSS. Some authors recommend prophylactic revascularisation whenever the left subclavian artery is sacrificed during TEVAR. However, transposition or bypass of this artery is not without risk and mild symptoms, such as secondary headache, can be fully controlled with conservative measures that reduce steal pathophysiology.

  • Headache (including migraines)
  • Vascular surgery
  • Neuroimaging
  • Interventional radiology

https://doi.org/10.1136/bcr-2022-249166

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    Footnotes

    • Contributors RR and AAA were involved with the management of the patient, conceptualisation of the case report, data collection, preparation of the manuscript, editing and approval of the final manuscript for publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.