Acute Basilar Artery Occlusion in a Patient With Left Subclavian Artery Occlusion Due to First Rib Anomaly -Case Report-

Abstract

A previously healthy 22-year-old man presented with thoracic outlet syndrome manifesting as Raynaud's phenomenon in the left hand and embolic occlusion of the basilar artery. Three-dimensional computed tomography angiography showed that the left subclavian artery was occluded as it passed over the abnormal first rib. Retrograde propagation of the thrombus from the site of arterial occlusion and/or reflux of embolic material was suspected. Medical therapy was started. The patient underwent resection of the anomalous rib. Postoperative angiography demonstrated that the subclavian artery was recanalized with almost normal distal flow. The basilar artery was also recanalized. Thoracic outlet syndrome due to a first rib anomaly may cause stroke.

Pearls & Oy-sters: Distal subclavian artery

“…Previous case reports have described distal subclavian artery disease secondary to TOS causing cerebral embolism. 7 The majority of these cases described right TOS leading to cerebral embolism, involving commonly the right middle cerebral artery. This phenomenon is possibly due to the anatomic characteristics of the right carotid artery branching from the brachiocephalic artery and the differences in caliber of the common carotid and vertebral arteries with reduced resistance seen in the larger common carotid artery.…”

Embolic Stroke and Pulseless Right Arm in a Schoolgirl with Arterial Thoracic Outlet Syndrome: A Case Report

“…Previous case reports have described distal subclavian artery disease secondary to TOS causing cerebral embolism 8 . The majority of these cases described right TOS leading to cerebral embolism, involving commonly the right middle cerebral artery.…”

An unusual case of the syndrome of cervical rib with subclavian artery thrombosis and cerebellar and cerebral infarctions

“…More recently, in a systematic review, Yamaguchi et al reported ten patients with cerebral embolism from subclavian artery thrombotic pathology caused by a cervical rib or the first rib anomaly [13]. In a study of 120 young stroke patients, retrograde embolism due to a right cervical rib-associated arterial lesion was the reported cause in only one patient [14].…”

“…Predilection of thromboembolism in the right cerebral and not cerebellar hemisphere is explained by the fact that only on that side the common carotid arises with the subclavian from the innominate [10]. This route of embolisation is also explained due to the larger caliber of and less vascular resistance in the common carotid than vertebral artery [13]. However, cerebellar infarction has been reported to occur if there is an extension of subclavian thrombus into the vertebral artery [24].…”