Subclavian atherectomy and angioplasty for coronary subclavian steal syndrome post CABG

Coronary subclavian steal syndrome is an uncommon complication occurring in patients with coronary artery bypass graft (CABG). We describe a case of a 69-year-old male with a remote history of CABG who presented with exertional left arm pain and angina. Computed Tomographic Angiography of the chest demonstrated a severe left proximal subclavian artery stenosis. The case demonstrates successful application of subclavian atherectomy with use of embolic protective device, alleviating the need of stent, for treatment of Coronary subclavian steal syndrome in patient with remote history of CABG.     

彩色多普勒超声对锁骨下动脉窃血综合征的诊断价值

目的:评价彩色多普勒超声对锁骨下动脉窃血综合征(SSS)的诊断价值,并对SSS的流行病学状况进行初步研究。方法:对5 362例接受颈动脉彩色多普勒超声检查的患者进行双上肢血压检测,对收缩压差(PD)>20 mmHg的患肢进行详细研究。结果:254例PD>20 mmHg。完全窃血121例、部分窃血86例,无窃血47例。207例诊断为SSS,43例有明显症状,其中后脑循环症状36例,心肌缺血4例,上肢缺血3例。PD值越大,症状越明显。结论:彩色多普勒超声对诊断SSS具有便捷、无创、重复性好等特点,是SSS的首选诊断方法。     

The role of magnetic resonance angiography in the diagnosis of subclavian steal

Purpose: To compare magnetic resonance angiography (MRA) with digital angiography for diagnosis of subclavian steal syndrome. Methods: A comparison study between MRA and digital contrast arteriography was carried out in 10 patients with suspected subclavian steal syndrome. Two of these patients were studied by MRA before and after percutaneous transluminal angioplasty (PTA). MRA was obtained on a 1.5 tesla superconductive magnet with linear head coil using a fast low angle shot (FLASH 2D) sequence in the axial plane as well as a fast imaging with steady state precession (FISP 3D) with velocity compensation gradient echo sequence in the coronal plane. The coronal images were used as source data for the construction of projection images with the use of a maximum-intensity pixel algorithm. The images were rotated from -45° to 45° in 15° steps. Results: All 10 patients had evidence of proximal subclavian artery obstruction and flow reversal in the ipsilateral vertebral artery. On MRA, consistent visualization of the affected vertebral artery in the FLASH 2D sequences and nonvisualization in the FISP 3D sequences was interpreted as an indirect sign of subclavian steal. The subclavian artery obstruction could not be assessed due to field size limits of MRA. Conclusion: MRA allows determination of flow reversal in the diagnosis of subclavian steal     

支气管动脉畸形的DSA表现及栓塞治疗

目的研究经皮血管内成形术（ＰＴＡ）及内支架治疗锁骨下动脉窃血综合征的疗效。方法 应用ＰＴＡ及内支架置入技术,治疗６例锁骨下动脉穿血综合征患者。结果 ６例造影显示锁骨下动脉有不同程度的狭窄（２条血管）和闭塞（４条血管）,均有窃血表现。４例经用导丝引导顺利完成ＰＴＡ治疗。     

锁骨下动脉盗血综合征介入治疗的疗效观察

目的探讨锁骨下动脉盗血综合征的介入治疗方法及疗效。方法应用经皮血管腔内支架植入术治疗因锁骨下动脉狭窄/闭塞致锁骨下动脉盗血综合征患者12例。结果血管内支架成形术治疗锁骨下动脉狭窄/闭塞患者手术成功率高,12例患者左锁骨下动脉血流完全通畅、椎动脉血流方向恢复,局部并发症少,其中1例采用经肱动脉和股动脉双入路交换导丝贯通行血管内支架成形治疗。结论经皮血管腔内成形术治疗锁骨下动脉盗血综合征是一种创伤小、疗效满意的治疗方法。     

肱动脉穿刺腔内治疗锁骨下动脉窃血综合征

目的 观察经肱动脉逆行穿刺行支架成形治疗锁骨下动脉窃血综合征的疗效.方法 解剖肱动脉后逆行穿刺,行支架成形术治疗15例锁骨下动脉窃血综合征患者.结果 15例均有锁骨下动脉窃血表现,MRA或DSA显示锁骨下动脉有不同程度的狭窄.所有病例在放置Wallstent或Palmaz支架后脉搏搏动恢复,临床症状消失,造影显示血管及支架恢复通畅,近期疗效满意.随访3～30个月均通畅,无症状复发.结论 使用解剖肱动脉后逆行穿刺支架成形术治疗锁骨下动脉窃血综合征更符合局部血管解剖特点,降低操作难度,提高手术成功率,是一种较理想的手术方式.     

经颅多普勒超声对锁骨下动脉盗血综合征的诊疗价值

目的通过分析锁骨下动脉盗血综合征（SSS）的经颅多普勒超声（TCD）检测结果及介入治疗前后的椎-基底动脉系统血流动力学改变,评价TCD在SSS中的应用价值。方法回顾性总结经TCD诊断的94例锁骨下动脉盗血综合征患者,均经彩色多普勒血流显像（CDFI）验证,且11例进一步经DSA检查证实。对15例患者分别于6～18个月内进行TCD随访。结果①94例患者中有症状者65例（表现为椎基底动脉供血不足58例,同侧患肢缺血症状6例,胸前区疼痛1例）,无症状者29例;②Ip-VAⅠ度盗血占45%,Ⅱ度盗血占35%,Ⅲ度盗血占20%。基底动脉（BA）参与盗血6例,大脑后动脉参与盗血2例。5例SSS患者颅内椎动脉Ⅱ度盗血,而颅外椎动脉Ⅲ度盗血;③94例患者中有15例患者分别于6～18内个月进行了随诊,有1例患者盗血程度加重,1例患者出现新的盗血途径。11例行DSA检查的患者中,只有4例经TCD检查示椎动脉Ⅲ度盗血的患者,在DSA中能观察到血流从对侧椎动脉反向流入狭窄侧椎动脉最后到狭窄侧远端锁骨下动脉的全过程。而其余7例TCD检查示椎动脉Ⅰ、Ⅱ度盗血的患者,DSA仅能看到部分血流逆转过程或仅表现为患侧椎动脉显影稍淡或正常。4例患者行血管内支架术治疗,在第18个月随访时,4例均无临床症状复发,2例TCD表现复发。结论①TCD是观察SSS现象及盗血程度的敏感可靠的方法,且能判断颅内基底动脉、大脑后动脉受影响的情况,能使更多的SSS患者及时得到正确诊断。②TCD经济,方便,无创,准确,可用于评价动脉内支架置入术的治疗效果及长期随诊。     

Colour doppler imaging of partial subclavian steal syndrome

The case of a 67-year-old woman with symptoms related to the vertebro-basilar system and blood pressure difference of the upper extremities is presented. Colour-Doppler imaging (CDI) with additional spectral tracing revealed partial subclavian steal syndrome with retrograde flow in the left vertebral artery during systole, which could be significantly enhanced by reactive hyperemia after of arm exercise. Angiography confirmed a highgrade stenosis of the proximal subclavian artery and balloon angioplasty was performed. Nonivasive follow-up by CDI demonstrated regular antegrade vertebral artery flow at rest, but minimal retrograde systolic flow after left arm exercise.     

彩超对锁骨下动脉窃血综合征的诊断分析

目的 探讨彩超对锁骨下动脉窃血综合征（SSS）的诊断价值。方法 分析20例临床诊断为SSS的椎动脉血流与锁骨下动脉、颈动脉、无名动脉病变及上肢动脉血流频谱的关系。结果 SSS的椎动脉血流可分为完全性椎动脉反流、部分性椎动脉反流和无椎动脉反流三种。结论 超声诊断SSS方法简便、经济、无创。     

3D CE-MRA联合2D TOF MRA诊断锁骨下动脉盗血综合征

目的:回顾性分析3DCE-MRA联合2DTOFMRA对锁骨下动脉盗血综合征(SSS)的诊断价值.方法:选择3例已证实的SSS患者,应用施加上饱和脉冲的2D TOF MRA行颈部定位像扫描,3D CE-MRA行颈部MRA检查.分析颈部动脉病变及椎动脉(VA)血流方向.结果:3例SSS患者定位像上一侧VA均未见显示,3D CE-MBA均见显示,提示血流反向.3D CE-MRA示3例同侧锁骨下动脉近端起始部重度狭窄或闭塞;1例伴同侧ICA重度狭窄和对侧CCA中度狭窄.结论:3D CE-MRA联合施加上饱和脉冲的2D TOF MRA诊断SSS快速、准确、可靠;同时能提供更多颈部动脉病变信息.     

锁骨下动脉窃血综合征的彩色多普勒超声与CTA的对比研究

目的探讨锁骨下动脉窃血综合征的彩色多普勒超声与CTA特征及诊断价值。方法回顾性分析2l例锁骨下动脉(subclavian artery,SCA)窃血综合征患者的超声及CTA资料,并进行对照分析。结果锁骨下窃血综合征发生于左侧病变l4例,右侧7例,其中部分窃血6例,完全窃血14例,其中锁骨下动脉起始部闭塞5例。患侧椎动脉反向程度与该侧锁骨下动脉或无名动脉狭窄程度与CTA对照呈正相关。结论椎动脉反流是诊断锁骨下动脉窃血综合征的重要依据之一,也是超声多普勒诊断锁骨下动脉窃血综合征的优势。锁骨下动脉管腔的真实狭窄程度CTA具有绝对的优势。     

Unusual subclavian steal: bidirectional and antegrade blood flow in the vertebral artery

We present an unusual radiographic manifestation of subclavian steal seen in six patients. These cases differ from the classic form of subclavian steal in that antegrade and bidirectional blood flow in the vertebral-subclavian antery system in seen, resulting in the steal phenomenon.     

Bilateral subclavian steal syndrome: Treatment with percutaneous transluminal angioplasty and stent placement

A 66-year-old man presented with bilateral subclavian steal syndrome (SSS) due to proximal subclavian artery occlusions. He was treated by percutaneous transluminal balloon angioplasty (PTA) and stent implantation in the left subclavian artery and by PTA alone in the right subclavian artery. We could demonstrate that interventional treatment of symptomatic bilateral SSS is possible. If PTA alone is insufficient, stent implantation should be considered.     

锁骨下动脉窃血综合征的血管内支架治疗

目的探讨血管内支架治疗锁骨下动脉窃血综合征的价值。方法对13例锁骨下动脉狭窄或闭塞性病变患者行血管内支架置入治疗,其中左锁骨下动脉近段重度狭窄7例、闭塞6例。结果 13例患者锁骨下动脉均成功置入内支架(均为自膨胀支架),术后患侧桡动脉、肱动脉搏动恢复正常,原有窃血现象消失,椎动脉顺行显影良好,4例锁骨下动脉完全闭塞患者采用经患侧肱动脉逆行法穿刺置入支架。结论血管内支架置入术治疗锁骨下动脉窃血综合征是一种安全、有效的微创治疗方法。     

彩色双功能超声在诊断锁骨下动脉窃血综合征中的临床应用

目的:探讨彩色双功能超声在诊断锁骨下动脉窃血综合症中的临床应用价值。方法:回顾性地分析经彩色双功能超声诊断的67例锁骨下动脉狭窄或闭塞的例,并与MRA、CTA及介入血管造影检查结果进行对比。结果:本组67例中,彩色双功能超声诊断锁骨下动脉窃血综合症准确率为94%,检出率为100%。结论:彩色双功能超声、CTA、MRA及介入血管造影检查在诊断锁骨下动脉窃血综合症的诊断过程中具有较高的临床应用价值,彩色双功能超声以其独特的优势,可作为本病影像学检查方法的首选。     

经颅多普勒与彩色多普勒超声对锁骨下动脉盗血综合征的诊断价值

目的:探讨经颅多普勒(TCD)与彩色多普勒超声对锁骨下动脉盗血综合征(SSS)的诊断价值。方法:应用彩色多普勒超声检测32例SSS患者的椎动脉颅外段、颈动脉、锁骨下动脉(SubA)、无名动脉的彩色血流形态,内-中膜厚度及狭窄程度;TCD检测椎动脉颅内段与基底动脉血流方向及频谱的改变。结果:32例中SubA中度狭窄11例,重度狭窄12例,闭塞9例。TCD检查Ⅰ期盗血11例(34%);Ⅱ期盗血11例(34%);Ⅲ期盗血10例(32%)。结论:彩色多普勒超声与TCD联合应用,通过对SubA及无名动脉的内-中膜厚度、狭窄程度及椎-基底动脉频谱形态的测量,有利于对SSS病因及程度的诊断。     

Congenital subclavian steal associated with an unusual type of right aortic arch

A case of congenital subclavian steal caused by a previously unreported aortic arch anomaly was demonstrated by angiography. The patient was shown to have a right aortic arch with a retroesophageal segment, a stenotic proximal portion of the left subclavian artery, and a left descending aorta.     

Subclavian steal phenomenon: a correlation between duplex sonographic and angiographic findings

Summary Correlation of duplex sonography, angiography of the vertebral artery, and the degree of subclavian or innominate stenosis was carried out in ten patients with the subclavian steal phenomenon. Four successive stages of Doppler waveform were identified by duplex sonography. Three angiographic patterns of decreasing severity, permanent reversal, to-and-fro motion and delayed opacification, were found. Permanent reversal angiograms corresponded to complete reversal or late transient Doppler waveforms. To-and-fro motion and delayed opacification angiograms did not necessarily have a corresponding Doppler pattern. The different stages of subclavian steal phenomenon on duplex sonography correlated significantly with the degree of subclavian or innominate stenosis. Stenosis of at least 60% was found to produce abnormal vertebral artery Doppler sonography, except in one patient. Duplex sonography is considered to be a sensitive and convenient method for detecting abnormal vertebral artery haemodynamics and the subclavian steal phenomenon, but some other factors may be important in producing the Doppler waveforms.     

SPECT evaluation of cerebral blood flow during arm exercise in patients with subclavian steal

Objectives To explore the cerebral hemodynamics in subclavian steal syndrome, we examined the cerebral perfusion of seven patients with subclavian steal (one symptomatic and six asymptomatic) using single-photon emission computed tomography (SPECT) during resting, arm exercise, and acetazolamide-activated conditions. Methods The regional CBF (rCBF) was measured with SPECT under all conditions, and region of interest (ROI) analysis was performed using a three-dimensional stereotaxic ROI template (3DSRT). We evaluated the relationship between arm exercise-induced rCBF change and (1) presence of subclavian artery stenosis, (2) vertebral reverse flow severity, (3) presence of vertebro-basilar insufficiency (VBI) symptoms, and (4) cerebrovascular reactivity (CVR) to acetazolamide. Results Overall, no arm exercise-induced rCBF reduction was observed on either the affected or the unaffected side, even in patients with severe vertebral reverse flow. One patient with VBI symptoms showed an arm exercise-induced global rCBF reduction in the cerebrum and cerebellum, whereas the other asymptomatic patients did not. The %rCBF changes in segments with severely impaired CVR (−8.6%± 10.7%, mean ± SD) were significantly lower than those in other segments with less impaired CVR (P < 0.01). Conclusions Our results suggest that subclavian steal is a benign condition in asymptomatic patients. On the other hand, arm exercise-induced rCBF reduction can occur in the cerebrum and cerebellum in patients with VBI symptoms possibly related to low CVR.