Because of the pressure gradient, an aortagram was done to examine the origin of the L. subclavian. This showed a tight stenosis of the proximal portion of the left subclavian. The patient was advised to undergo stenting.
A right Judkins 6F diagnostic catheter was used to select the L. subclavian by counterclockwise rotation after passage around the arch over a .035" Wholey wire. The wire was advanced through the stenosis and passed to the distal subclavian. The catheter was then passed over the wire and the wire was exchanged for an .038" J exchange wire. A 9F Multipurpose guide was then placed over the exchange wire to the ostium of the L. subclavian. A Cordis medium length 10mm Smartstent was then placed over the wire and post-dilated with a 9mm balloon leaving no residual stenosis or pullback gradient.
After stenting, the patient had no further gradient between the right and left arm blood pressures, and has remained asymptomatic.
See our discussion of Subclavian Stenosis and Steal Syndrome