Vertebral arterial flow reversal in proximal subclavian artery occlusion
Recurrent drop attacks. Dizzyness. Blood pressure difference between right and left arm.
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No (antegrade) flow signal in the left VA on 3D TOF images. CE-MRA shows that the left arm is supplied by a collateral circulation, that involves retrograde perfusion of the left vertebral artery.
The left VA flow signal on the 3D multislab TOF images is absent due to ramped flip angles and superior sat pulse.