Angiography after catheterization of the innominate artery near the origin of the right common carotid and subclavian arteries demonstrating the occlusion of the brachiocephalic trunk (bold black arrow). Note that contrast media is not running along 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 the generalized atherosclerotic disease. Stenotic lesions of initial and mid-portion segments in the subclavian artery were not considered to be that significant for acute treatment. In case they progressed we considered endovascular treatment. White arrow: pacemaker wire.