1.What is subclavian artery? What is subclavian artery stenosis? After the heart sends out the aorta, the aorta divides into two important branches that supply blood to both upper limbs, called the subclavian artery. In the path to both upper limbs, the subclavian artery sends out branch vessels upward into the brain to supply the cerebellum, and these two branches are called vertebral arteries. Arteriosclerosis or inflammation of the arteries causes the lumen of the subclavian artery to thin and affects the distal blood flow, which is called subclavian artery stenosis. If the stenosis is not treated in time, the degree of stenosis will gradually increase, even to the point of complete occlusion of the vessel. Once the subclavian artery becomes severely stenosed by more than 70%, the blood flow to both upper limbs and the cerebellum will be significantly reduced and symptoms of ischemia will appear. 2.Why does “blood theft” occur? When the opening of the subclavian artery is narrowed or occluded, the blood flow to the upper limbs and cerebellum will be reduced, and when the movement of the upper limbs increases, they cannot get enough blood supply through the starting part of the subclavian artery, so they will “steal blood” from the cerebellum through the vertebral artery, a branch of the subclavian artery. Not only does the cerebellum not get blood supply, but the limited blood flow is also stolen by the “neighbor” of the arm, resulting in severe ischemia of the cerebellum, a phenomenon known as “subclavian artery blood theft This phenomenon is called “subclavian artery blood theft”. 3.What are the symptoms of subclavian artery stenosis? The clinical symptoms of subclavian artery stenosis are roughly divided into two categories, one is the ischemic symptoms of the upper extremities caused by insufficient blood supply to the upper extremities, manifested as weakness, coldness and numbness of the upper extremities, especially obvious after the increase in upper extremity activity, easy fatigue after upper extremity activity, patients will occasionally find that the pulse on both sides is asymmetrical when feeling the pulse, with the affected side having a weak pulse and the contralateral side having a strong pulse. The other category is cerebellar ischemia symptoms caused by insufficient blood supply to the vertebral artery, mainly manifested as vertigo, double vision, uncoordinated hand movements, unstable walking, the feeling of one foot high and one foot low, and sometimes sudden fainting, and some patients with severe lesions also have increased activity of the upper limbs through the vertebral artery “blood theft”, resulting in heavier symptoms of cerebellar ischemia, the above symptoms may be more obvious, in the long run, may have adverse effects on the health of brain tissue, and a few patients may even suddenly develop cerebellar infarction. 4.When does surgery need to be done? If the stenosis of the subclavian artery is severe, exceeding 70%, or if the examination reveals the existence of “subclavian artery steal”, and the clinical symptoms of ischemia in the upper limbs and cerebellar ischemia are obvious, active surgery is needed. If the stenosis is advanced and the stenosis is severe or even occluded, an experienced vascular surgeon can still try to treat the stenosis with minimally invasive intervention, but if the stenosis is so hard that the guidewire cannot be passed, the patient can only be treated with subclavian artery bypass surgery. If the lesion is so hard that the guidewire cannot pass, the patient can only perform subclavian artery bypass surgery. 5.Is the surgery dangerous and what else should I pay attention to after the surgery? Early lesions can be treated through minimally invasive interventional techniques by simply puncturing the root of the thigh or upper extremity, placing a guidewire, and placing a stent through the guidewire, which is minimally invasive and can be discharged from the hospital within 1-2 days after surgery. If the lesion is severe and has developed into an occlusion, stenting can still be tried first. After repeated attempts by experienced vascular surgeons, if the guidewire still cannot pass through the lesion, open surgery must be performed to open the occlusion of the subclavian artery through carotid and subclavian artery bypass or bilateral subclavian artery bypass, which requires about 1 week to remove the stitches after surgery. Both minimally invasive surgery and open surgery are well-established treatments that can be performed in experienced vascular surgery centers. The risks of surgery often come from the patient’s systemic condition, and factors such as advanced age, hypertension, diabetes, and atherosclerosis can cause potential risks to the heart, brain, lungs, and other organs during the perioperative period and need to be closely monitored. Whether minimally invasive surgery or open surgery, regular postoperative review, long-term antiplatelet medication, and in some patients, anticoagulant medication, in addition to smoking cessation and strict control of blood pressure, blood sugar, and lipids, are important measures to maintain the patency of the stent or artificial vessel. 6.Can subclavian artery stenosis be treated by medication? So far, there is still no drug that can eliminate plaque, open the stenosis and restore blood flow. However, some measures can control atherosclerosis and slow down the progression of subclavian artery stenosis. Patients often need to make good lifestyle adjustments, pay attention to controlling the risk factors of atherosclerosis, such as increasing exercise, quitting smoking, drinking less alcohol, actively treating hypertension, hyperlipidemia and diabetes, changing the unreasonable diet structure, eating less high-fat foods, such as pork and beef, eating appropriate poultry and fish foods, eating less fried foods and eating more healthy foods. Those who already have atherosclerosis and mild stenosis of the subclavian artery need to see a vascular surgeon promptly, take antiplatelet drugs and other related medications as prescribed by the doctor, and have regular checkups to prevent further development of the stenosis.