Subclavian steal-carotid recovery phenomenon. Experience of 7 operated patients.

Subclavian steal-carotid recovery phenomenon, which accompanies an occlusion of the brachiocephalic trunk, is a rare cause of transient ischemic attacks. In the actual study, including 7 operated patients, preoperative symptoms, results of directional Doppler ultrasound examinations further evaluated by sonography, angiography, peroperative flowmetry and postoperative outcome are presented and discussed. Fits of vertigo, right-sided blindness and left-sided paralysis were the most common symptoms. Retrograde vertebral artery, antegrade common carotid and supraorbital artery blood flow was found by ultrasound. Analysis of the audio-frequency obtained by ultrasound revealed, however, preoperative abnormal flow of the common carotid artery. In 6 patients, angiography revealed retrograde vertebral but antegrade common carotid artery blood flow and in the 7th patient, both vertebral and common carotid artery blood flow was reversed. Peroperative flowmetry revealed increased retrograde blood flow of the vertebral and change from ante- to retrograde flow of the common carotid artery during hyperemia of the right arm. One patient died after 40 days due to sepsis, the focus of which was neither traced clinically nor at autopsy. One patient, who was free of preoperative symptoms, died after 4 years from myocardial infarct. Five patients are alive, 4 are completely free and another improved from the preoperative symptoms after 1-7 years.