![]() ![]() Asymptomatic cases should be managed conservatively with regard to vascular risk factor modification and antiplatelet therapy. The key signs of a subclavian steal are markedly diminished, delayed, or absent radial pulses on the affected side supraclavicular systolic bruits and asymmetric brachial blood pressures, with the lower systolic pressure on the affected side, and generally with a minimum difference of 20 mmHg. In a minority of cases, neurologic symptoms may be precipitated by ipsilateral arm exercise, head turning, or standing up. In most patients with subclavian steal, the steal is asymptomatic (subclavian steal phenomenon), but a minority may have ischemic symptoms referable to the posterior circulation or the arm. With subclavian artery stenosis proximal to the takeoff of the vertebral artery, there is a compensatory shunting of blood from the ipsilateral vertebral artery to supply the arm, thus, “stealing” blood from the vertebrobasilar system.
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