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So this is a case of vertebral artery reversal in the setting of subclavian steal

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syndrome. So starting on the right side, notoriously challenging to see the

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vertebral arteries because of all the structures over top, but we do visualize here

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that we see an artery, and then the right artery is going antegrade.

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We can see the vessel coursing up that direction.

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It is going towards the patient's head.

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When we move over to the left side

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and we get to the left vertebral artery, you can see that the waveform looks

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significantly different. Instead of going towards the transducer here as the vessel

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courses up towards the head, it's going away from the transducer.

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So that is showing us, and we see this waveform, a pretty significant dip and

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reversal below the baseline. There are portions where you see some above the

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baseline, but it's predominantly below, especially during systole, and this is

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pretty indicative of subclavian steal.

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So when you have a significant stenosis in the subclavian artery proximal to this,

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it is pulling a significant amount of that flow down during systole, and only a

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small amount during diastole is coming back.

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So this is what it looks like when you have near complete reversal of that left

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vertebral artery.