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The subclavian steal phenomenon: A common vascular disorder with rare neurologic deficits
Abstract
This study aimed to quantify core surgical trainee (CST) differential attainment (DA) related to three cohorts; white UK graduate (White UKG) versus black and minority ethnic UKG (BME UKG) versus international medical graduates (IMGs). The primary outcome measures were annual review of competence progression (ARCP) outcome, intercollegiate Membership of the Royal College of Surgeons (iMRCS) examination pass and national training number (NTN) selection. Intercollegiate Surgical Curriculum Programme (ISCP) portfolios of 264 consecutive CSTs (2010–2017, 168 white UKG, 66 BME UKG, 30 IMG) from a single UK regional post graduate medical region (Wales) were examined. Data collected prospectively over an 8-year time period was analysed retrospectively. ARCP outcomes were similar irrespective of ethnicity or nationality (ARCP outcome 1, white UKG 60.7% vs BME UKG 62.1% vs IMG 53.3%, p=0.395). iMRCS pass rates for white UKG vs BME UKG vs IMG were 71.4% vs 71.2% vs 50.0% (p=0.042), respectively. NTN success rates for white UKG vs BME UKG vs IMG were 36.9% vs 36.4% vs 6.7% (p=0.023), respectively. On multivariable analysis, operative experience (OR 1.002, 95% CI 1.001 to 1.004, p=0.004), bootcamp attendance (OR 2.615, 95% CI 1.403 to 4.871, p=0.002), and UKG (OR 7.081, 95% CI 1.556 to 32.230, p=0.011), were associated with NTN appointment. Although outcomes related to BME DA were equitable, important DA variation was apparent among IMGs, with iMRCS pass 21.4% lower and NTN success sixfold less likely than UKG. Targeted counter measures are required to let equity prevail in UK CST programmes.
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“When detected with ultrasound, steal is asymptomatic in 64% of cases.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [422]
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Items 201–234 of 234
Vascular Imaging in Transient Ischemic Attack and Stroke
Lau, G. K. K., Pendlebury, S. T., & Rothwell, P. M. (2018) · Cambridge University Press eBooks · doi:10.1017/9781316161609.013
Caplan, L. R. (2015) · Cambridge University Press eBooks · doi:10.1017/cbo9781139019453.004
Successful Angioplasty of Left Vertebral Artery and Right Subclavian Artery Via Retrograde Approach
Namazi, M. H. (2017) · JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · doi:10.7860/jcdr/2017/22254.9257
Todua, F., & Gachechiladze, D. (2018) · Springer eBooks · doi:10.1007/978-3-319-91367-4_16
Artériopathies athéromateuses des membres supérieurs
Aboyans, V. (2016) · Elsevier eBooks · doi:10.1016/b978-2-294-74970-4.00026-9
Which arterial territory is involved?
Brust, J. C. M. (2019) · doi:10.1002/9781118492390.ch4
Wilterdink, J. L. (2004) · doi:10.1002/9780470988442.ch7
General Features of Cerebrovascular Disease in the Posterior Circulation
Caplan, L. R. (2015)
Percutaneous Transluminal Angioplasty of the Subclavian Arteries
Henry, M., henry, I. P., Polydorou, A., et al. (2011) · doi:10.1002/9781444329803.ch49
Lang, W. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511691768.010
Langzeitergebnisse nach PTA und Stentangioplastie bei Subklavialäsionen
Tesdal, I. K. (2001) · Steinkopff eBooks · doi:10.1007/978-3-662-26791-2_24
History of Vertebrobasilar Territory Stroke and TIA
Caplan, L. R. (2020) · Springer eBooks · doi:10.1007/978-981-15-6739-1_1
Essa, R. A., Ahmed, S. K., Abdulsahib, S. H., et al. (2020) · Journal of Medical Internet Research · doi:10.2196/24195
Incidence of Subclavian Steal as Detected by Carotid Duplex Ultrasound and Clinical Implications
Beasley, M., Davis, M., & AbuRahma, A. F. (2021) · Springer eBooks · doi:10.1007/978-3-030-49616-6_65-1
Extrathoracic Surgical Treatment of Subclavian Steal Syndrome
Salem, M., Salem, A. M., & Salem, S. M. (2017) · Ain Shams Journal of Surgery · doi:10.21608/asjs.2017.178201
Posterior Circulation Ischemia: Specific Vascular Sites and Conditions
Caplan, L. R. (2015)
Al-Senani, F. M., & Alexandrov, A. V. (2004) · doi:10.1002/9780470752883.ch17
Bradač, G. B. (2014) · Springer eBooks · doi:10.1007/978-3-642-54404-0_15
Shin, J., & Musani, M. H. (2015) · Springer eBooks · doi:10.1007/978-3-319-08168-7_8
Doppler Ultrasound of the Carotid and Vertebral Arteries
Raffaelli, C., Tran, C., & Amoretti, N. (2002) · Medical radiology · doi:10.1007/978-3-642-56213-6_6
Vascular imaging in transient ischemic attack and stroke
Pendlebury, S. T., Giles, M. F., & Rothwell, P. M. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511575815.013
Bradač, G. B. (2011) · Springer eBooks · doi:10.1007/978-3-642-15678-6_15
Kuwabara, M., Sakamoto, S., Okazaki, T., et al. (2022) · Acta Neurochirurgica · doi:10.1007/s00701-022-05367-8
A Case of Subclavian Steal Syndrome with Occlusion of the Internal Carotid Artery
Toyoda, I., MIKABE, T., & KAZUNO, T. (1998) · Surgery for Cerebral Stroke · doi:10.2335/scs1987.26.1_50
Navigating Subclavian Artery Stenosis in Pregnancy: A Multidisciplinary Approach to a High-Risk Case
Patel, D. J., Chaudhari, K., Gupta, A., et al. (2023) · Cureus · doi:10.7759/cureus.43933
“This disorder thus increases the chances of symptomatic coronary artery disease and cerebrovascular events in those who are affected by it [6-8].”
BackgroundAtypical presentation of subclavian steal syndrome with left sided sensorineural deafness
Rolon, S., Wood, J. C., Gableman, A., et al. (2023) · Journal of Vascular Surgery Cases and Innovative Techniques · doi:10.1016/j.jvscit.2023.101308
Frequency of subclavian steal syndrome in a sample of non-Western population
Elhfnawy, A. M., Abdelkhalek, H., & Elkordy, A. M. (2024) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2024.123353
High Suited Carotid Artery Stenosis and Imaging
Butz, B. (2007) · Springer eBooks · doi:10.1007/978-3-211-32509-4_11
Surgery and the Vertebral Arteries
Barkauskas, E., & Pauliukas, P. (2000) · Springer eBooks · doi:10.1007/978-1-4612-1190-7_56
Hacke, W., Gelmers, H. J., Hennerici, M. G., & Krämer, G. (1991) · Springer eBooks · doi:10.1007/978-3-642-75548-4_6
Self-citation
Metadata
- Authors
- Hennerici, M., Klemm, C., & Rautenberg, W.
- Affiliations
- Heinrich Heine University Düsseldorf (DE)
- Venue
- Neurology
- Published
- 1988-05
- Volume
- 38
- Issue
- 5
- Pages
- 669-669
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W2119374834
- Cited by
- 235
- References
- 0
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 7 · 2020: 4 · 2019: 4 · 2018: 5 · 2017: 5 · 2016: 6 · 2015: 13 · 2014: 11 · 2013: 9 · 2012: 6
- FWCI
- 9.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Education › Innovations in Medical Education
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Health Sciences › Medicine › Surgery › Surgical Simulation and Training
- Keywords
- subclavian steal syndrome, vertebral artery, subclavian artery, vertebral artery insufficiency, vertebral artery dissection
- MeSH terms
- Aged, Basilar Artery, Blood Flow Velocity, Brain Ischemia, Ischemic Attack, Transient, Female, Follow-Up Studies, Humans, Male, Nervous System Diseases, Regional Blood Flow, Subclavian Steal Syndrome, Vertebral Artery
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