A case of successful correction of subclavian steal syndrome by percutaneous transluminal angioplasty with stenting in a male patient who found incidentally signifi cant interarm blood pressure difference. Small difference in blood pressure (BP) between two arms is a relatively common. Significant interarm BP difference is a potential marker of peripheral vascular disease such as subclavian artery stenosis and a predictor of cardiovascular disease. The subclavian steal syndrome is a condition that results from stenosis of subclavian artery proximal to the vertebral artery. The resulting symptoms are vertebrobasilar insuffi ciency symptoms due to reversal of blood fl ow from the contralateral vertebral and basilar artery into the ipsilateral upper extremity vessels and arm ischemic symptoms. Stenotic lesion of subclavian artery has traditionally been treated surgically. However recent trends are undergoing a paradigm shift from open surgery to endovascular approach. We report a patient with subclavian steal syndrome who found incidentally 35 mmHg interarm systolic BP difference. It was successfully treated by percutaneus transradial angioplasty with stenting on stenotic lesion of the subclavian artery.

Citations

• Duplex Sonography in Subclavian Steal Syndrome Treated by Stent Insertion
  Minho Han
  The Korean Journal of Clinical Laboratory Science.2018; 50(3): 370.     CrossRef
• The Role of Duplex Sonography in Right Subclavian Double Steal Syndrome
  Minho Han, Bok Hee Jin, Hyo Suk Nam
  The Korean Journal of Clinical Laboratory Science.2017; 49(3): 316.     CrossRef
• Inter-arm Differences in Simultaneous Blood Pressure Measurements in Ambulatory Patients without Cardiovascular Diseases
  Kyoung Bog Kim, Mi Kyeong Oh, Haa Gyoung Kim, Ji Hoon Ki, Soo Hee Lee, Su Min Kim
  Korean Journal of Family Medicine.2013; 34(2): 98.     CrossRef

Background
: Hypertension is a main cause of heart blood vessel disease. To diagnose and treat hypertension, it is necessary to measure blood pressure accurately. There are various factors that influence blood pressure. According to real clinical demonstrators and some recent studies, blood pressure differences between right and left arms are often observed. This study was intended to know whether the differences are really found and wheather the correlation exists between mid-arm circumferences and the blood pressure differences according to right-handed or left-handed which were considered as an important factor in affecting blood pressures.

Methods : One hundred sixty nine college freshmen of year 2001 were chosen. Among them, 103 were right- handed and 66 left-handed. Which arms to be checked first were determined randomly. This sequence was repeated two times on each person. Their mid-arm circumferences were measured, also.

Results : For right-handed persons, systolic blood pressure in right arm (119.2±12.3 mmHg) was significantly higher than in left arm (118.0±12.0 mmHg) (P＜0.005). But diastolic blood pressure differences between right arm (75.3±10.0 mmHg) and left arm (75.0±9.5 mmHg) was not significant statistically. For left-handed persons, systolic blood pressure was 120.3±9.9 mmHg in right arm and 120.0±10.3 mmHg in left arm. However, diastolic blood pressure in right arm (76.7±9.4 mmHg) was significantly higher than in left arm (75.0±8.6 mmHg) (P＜0.005). For right handed persons, their arm circumferences (26.2±2.8 cm) were significantly thicker than left ones (25.9±2.9 cm). For left-handed, left arm circumference (25.9±2.7 cm) was significantly thicker than right one (25.5±2.6 cm). As for the blood pressure difference in arm tested order, the first measured systolic blood pressure (right arm; 120.9±11.7 mmHg, left arm; 120.0±11.9 mmHg) was significantly higher than the second measured one (right arm; 118.3±11.8 mmHg, left arm; 117.8±11.6 mmHg) (P＜0.005). However, the first measured diastolic blood pressure (right arm; 76.3±10.5 mmHg, left arm; 75.5±9.4 mmHg) did not have more significance than the second measured one (right arm; 75.4±9.9 mmHg, left arm; 74.6±10.8 mmHg).

Conclusion : The right-handed person's blood pressure was higher in the right arm, but for the left-handed persons it was not significantly different in both arms. The second measurement of blood pressure was lower than the first measurement in both arms. The arm circumference depending on the right/left-handedness influenced the blood pressure, but clear correlation between them was not observed. Therefore, if possible, when the blood pressure is measured, it is advised to check blood pressure in both arms before diagnosing hypertension.