Occlusion of the brachiocephalic trunk (angiography)

Angiography after catheterization of the innominate artery near the origin of the right common carotid and subclavian arteries demonstrating occlusion of the brachiocephalic trunk (bold black arrow). Contrast media does not pass into the right vertebral artery due to the retrograde blood flow in the vessel (subclavian-vertebral steal syndrome). Concomitant stenosis of the common carotid artery (thin black arrow) is a manifestation of generalized atherosclerotic disease. White arrow: pacemaker wire. (Source: Filis K, Toufektzian L, Sigala F, et al. Right subclavian double steal syndrome: a case report. J Med Case Rep 2008;2:392. Creative Commons Attribution [CC BY] license, creativecommons.org/licenses/by/2.0.)