Recently, the interventional team of the Department of Neurology of Shanghai Jiuxin North Hospital/Third Hospital successfully performed subclavian artery opening under local anesthesia for a patient who presented with recurrent episodes of dizziness and complete occlusion of the right subclavian artery. The patient, a 72-year-old male, presented to the neurology clinic with recurrent episodes of dizziness, and a CT angiogram (CTA) of the neck revealed a complete occlusion of the beginning of the right subclavian artery. Since the subclavian artery is responsible for supplying blood to the intracranial vertebral artery, shoulder and neck, and upper extremities, once occluded, it will cause ischemia in the upper extremities (manifested by low blood pressure in the upper extremities, significantly weakened pulse, coldness and weakness in the extremities), and it will “steal” some of the blood flow from the intracranial blood flow to supply the upper extremities, which will cause the patient to suffer from This can lead to cerebral ischemia, which can be manifested as dizziness, syncope, or even ischemic stroke (i.e., cerebral infarction). After a detailed explanation of the patient’s condition and thorough preoperative preparation, under local anesthesia, a soft catheter and other devices were placed through two small openings at the root of the thigh and the right wrist to the lesion site, and the occluded artery was patiently opened using modern medical high-tech materials under the supervision of computerized imaging instruments, followed by balloon dilation and stent implantation. The originally occluded vessels were completely opened after stent implantation. The blood supply to the upper extremities and the cranium improved significantly, and the patient’s dizziness improved significantly; due to the restoration of blood flow to the affected upper extremity, the blood pressure measured on both upper arms was completely consistent and normal (before surgery, the systolic pressure on the affected side was 40 mmHg lower than that on the opposite side). The main surgical procedure was completed within 1.5 hours. The patient had no discomfort at all throughout the procedure. The patient’s family expressed great satisfaction due to the thoughtful and meticulous preoperative and postoperative observation and treatment. With the aging of society, the proportion of elderly patients is increasing year by year. Elderly patients often have lesions of intracranial and extracranial arterial stenosis or occlusion. If there is a significantly weaker pulse in one arm than the opposite side, significantly lower blood pressure than the opposite side (e.g., systolic blood pressure is more than 20 mm Hg lower), usually prone to dizziness and syncope, and accompanied by risk factors such as hypertension and diabetes, then it is necessary to rule out the possibility of subclavian artery stenosis or occlusion. The subclavian artery is a large vessel that originates from the aorta and supplies the skull, shoulder, neck and arm. The methods used to screen for stenosis of the subclavian artery include ultrasound, CT angiography (CTA) of the neck, and magnetic resonance angiography (MRA) of the neck. If a stenosis or occlusion is found, further consultation can be made at the neurology clinic.
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