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In the neurovascular setting, this can lead to entities such as subclavian steal syndrome or the less prevalent double steal phenomenon, primarily associated with atherosclerosis. We present a case of an early 80s patient with cerebrovascular insufficiency who exhibited neurological deficits during mastication. The angiographic evaluation showed occlusion at the origins of the left common carotid and of the brachiocephalic trunk. This configuration caused the left vertebral artery to be the only vessel filling anterograde. The flow in the right vertebral artery is retrograde, filling the subclavian and the right common carotid artery. Endovascular revascularization of the brachiocephalic trunk was successfully performed using a Gore Viabahn VBX Balloon Expandable Stent (W.L. Gore &amp; Associates, Flagstaff, AZ, USA), leading to symptom resolution.<\/jats:p>","DOI":"10.1093\/jscr\/rjae585","type":"journal-article","created":{"date-parts":[[2024,10,2]],"date-time":"2024-10-02T10:55:08Z","timestamp":1727866508000},"source":"Crossref","is-referenced-by-count":0,"title":["Recurrent syncope during mastication"],"prefix":"10.1093","volume":"2024","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9847-2685","authenticated-orcid":false,"given":"Otavio F","family":"De Toledo","sequence":"first","affiliation":[{"name":"Lyerly Neurosurgery, Baptist Neurological Institute , 800 Prudential Dr Suite 1100, Jacksonville, FL 32207 ,","place":["United States"]},{"name":"Research Department, Jacksonville University , 2800 University Blvd N, Jacksonville, FL 32211 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvador F","family":"Gutierrez-Aguirre","sequence":"additional","affiliation":[{"name":"Lyerly Neurosurgery, Baptist Neurological Institute , 800 Prudential Dr Suite 1100, Jacksonville, FL 32207 ,","place":["United States"]},{"name":"Research Department, Jacksonville University , 2800 University Blvd N, Jacksonville, FL 32211 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mateus R","family":"Alessi","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidade Positivo , Rua Professor Pedro Viriato Parigot de Souza 5300 - Campo Comprido Curitiba 81280-330, Parana ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor H C","family":"Benalia","sequence":"additional","affiliation":[{"name":"Lyerly Neurosurgery, Baptist Neurological Institute , 800 Prudential Dr Suite 1100, Jacksonville, FL 32207 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinicius Q","family":"Aguiar","sequence":"additional","affiliation":[{"name":"Centro Universitario de Volta Redonda , Av. Doutor Peixoto de Ara\u00fajo, 1325, Tr\u00eas Po\u00e7os, CEP 27240-560, Volta Redonda, RJ ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amin","family":"Aghaebrahim","sequence":"additional","affiliation":[{"name":"Lyerly Neurosurgery, Baptist Neurological Institute , 800 Prudential Dr Suite 1100, Jacksonville, FL 32207 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo A","family":"Hanel","sequence":"additional","affiliation":[{"name":"Lyerly Neurosurgery, Baptist Neurological Institute , 800 Prudential Dr Suite 1100, Jacksonville, FL 32207 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Sauvageau","sequence":"additional","affiliation":[{"name":"Lyerly Neurosurgery, Baptist Neurological Institute , 800 Prudential Dr Suite 1100, Jacksonville, FL 32207 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,10,2]]},"reference":[{"key":"2024100210545657300_ref1","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1146\/annurev.me.26.020175.001541","article-title":"The steal syndromes","volume":"26","author":"Toole","year":"1975","journal-title":"Annu Rev Med"},{"key":"2024100210545657300_ref2","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.ejvs.2010.03.017","article-title":"Percutaneous endovascular treatment of innominate artery lesions: a single-centre experience on 77 lesions","volume":"40","author":"Paukovits","year":"2010","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2024100210545657300_ref3","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10225237","article-title":"Prevalence and clinical characteristics of subclavian steal phenomenon\/syndrome in patients with acute ischemic stroke","volume":"10","author":"Bajko","year":"2021","journal-title":"J Clin Med"},{"key":"2024100210545657300_ref4","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1007\/s10396-016-0713-1","article-title":"Double steal phenomenon secondary to innominate artery occlusion","volume":"43","author":"Esen","year":"2016","journal-title":"J Med Ultrason (2001)"},{"key":"2024100210545657300_ref5","doi-asserted-by":"publisher","DOI":"10.1080\/08998280.2017.11929619","article-title":"Deglutition syncope","volume":"30","author":"Patel","year":"2017","journal-title":"Proc (Bayl Univ Med Cent)"},{"key":"2024100210545657300_ref6","doi-asserted-by":"publisher","first-page":"20","DOI":"10.14309\/crj.2015.88","article-title":"Deglutition syncope: a case report and review of the literature","volume":"3","author":"Kahn","year":"2015","journal-title":"ACG Case Rep J"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2024\/10\/rjae585\/59493379\/rjae585.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2024\/10\/rjae585\/59493379\/rjae585.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,2]],"date-time":"2024-10-02T10:55:09Z","timestamp":1727866509000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjae585\/7801607"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,1]]},"references-count":6,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjae585","relation":{},"ISSN":["2042-8812"],"issn-type":[{"type":"electronic","value":"2042-8812"}],"subject":[],"published-other":{"date-parts":[[2024,10]]},"published":{"date-parts":[[2024,10,1]]},"article-number":"rjae585"}}