A 64-Year-Old Man with Type 2 Diabetes Mellitus Is Evaluated

A 64-year-old man with type 2 diabetes mellitus is evaluated in the clinic due to occasional dizziness.  His symptoms usually occur while playing table tennis.  The patient has not had any falls or loss of consciousness.  He has no known history of coronary artery disease or stroke.  The patient has smoked a pack of cigarettes daily for the past 40 years and occasionally drinks alcohol.  Orthostatic vital signs are normal.  ECG shows normal sinus rhythm.  Doppler ultrasound evaluation of the left vertebral artery reveals retrograde (caudal) flow instead of normal antegrade flow.  Which of the following arteries is most likely to be occluded based on these ultrasound findings?

A) Innominate artery
B) Left internal carotid
C) Left internal mammary
D) Left subclavian
E) Right vertebral

Correct Answer:

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