彩色多普勒超声诊断锁骨下动脉盗血综合征

目的总结锁骨下动脉盗血综合征（SSS）的病因、二维超声表现、彩色多普勒及频谱多普勒特点,评价超声对此病的诊断价值。方法应用Philips Sonos 4500型彩色多普勒超声诊断仪对15例锁骨下动脉盗血综合征患者椎动脉颅外段、锁骨下动脉、无名动脉、双上肢动脉进行超声检查,观察其超声表现及血流动力学变化。结果15例患者中动脉粥样硬化12例,大动脉炎3例。完全性盗血8例,部分性盗血7例。结论SSS的主要病因是动脉粥样硬化和大动脉炎,彩色多普勒超声可对SSS作出明确诊新、有效评价其血流动力学变化。     

经颅多普勒对椎动脉盗血的分类诊断价值

目的 探讨经颅多普勒超声（TCD）对椎动脉盗血频谱的分类诊断的价值。方法 收集和分析TCD显示一侧椎动脉呈盗血血流频谱同时行颈部CT血管成像（CTA）或磁共振血管成像（MRA）检查的22例病例的临床和影像学检查资料。TCD对椎动脉盗血严重程度分级,CTA和MRA评价血管的狭窄程度。病例分为单纯锁骨下动脉狭窄、锁骨下动脉狭窄伴患侧椎动脉纤细或狭窄、单纯椎动脉盗血3组,并分析3组间临床指标和椎动脉TCD参数。结果 22例病例中,单纯锁骨下动脉狭窄者10例,锁骨下动脉狭窄伴患侧椎动脉纤细或狭窄者7例,单纯椎动脉盗血5例。单纯锁骨下动脉狭窄组、锁骨下动脉狭窄伴患侧椎动脉纤细或狭窄组、单纯椎动脉盗血组女性发病率分别为10%、40%、60%,右侧发生率分别为10%、57%、40%,隐匿型盗血的发生率分别为0、43%、60%,平均年龄分别为68岁、68岁、78岁。单纯椎动脉盗血组患侧椎动脉反向峰值流速（48±34）cm/s,单纯锁骨下动脉狭窄组、锁骨下动脉狭窄伴患侧椎动脉纤细或狭窄组患侧椎动脉反向峰值流速（9±14）cm/s,2组比较有统计学差异（Z=-2.219,P=0.026）。利用测量患侧椎动...     

锁骨下动脉窃血患者代偿动脉经颅多普勒分析

目的探讨锁骨下动脉窃血患者健侧椎动脉和基底动脉的血流动力学变化情况。方法应用经颅多普勒检测37例锁骨下动脉窃血患者的颅内动脉血流频谱变化,重点分析健侧椎动脉和基底动脉的血流速度、搏动指数,并与30例健康者对比。结果健侧椎动脉血流速度与正常组比较无明显差异,搏动指数与正常组和大脑中动脉比较明显增高;基底动脉血流速度与正常组比较明显减低,搏动指数与正常组和大脑中动脉比较无显著性差异。结论经颅多普勒可较准确反映锁骨下动脉窃血患者多血管血流动力学的变化情况。     

经颅多普勒与彩色多普勒超声显像技术联合应用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)与彩色多普勒超声显像(CDFI)技术联合应用对锁骨下动脉盗血综合征(SSS)的诊断价值.方法 对25例临床表现为椎一基底动脉供血不足的经TCD与CDFI联合检测证实的SSS患者的TCD与CDFI资料进行分析.结果 TCD检测显示:25例患者患侧椎动脉均为正向血流(血流信号逆转),其中完全性盗血8例(32%),部分性盗血17例(68%).CDFI检测显示:25例患者中23例(92%)锁骨下动脉起始段探及动脉粥样硬化斑块,2例(8%)动脉内膜增厚,25例血管内径明显变窄,甚至完全闭塞;血流柬变细或无血流信号;患侧椎动脉管腔内呈红蓝交替的双向血流或转为完全出颅方向的血流,并出现相应血流动力学改变.结论 TCD与CDFI联合应用对SSS能更准确地作出诊断.     

经颅多普勒超声在诊断锁骨下动脉盗血综合征中的应用

经颅多普勒超声（transcranial doppler,TCD）是用于筛查颅内外大动脉血流动力学的检查方法,对于血流速度和血流方向的变化极为敏感。TCD可以根据椎动脉（vertebral artery,VA）及基底动脉（BA）的血流频谱的特征性改变发现盗血并初步判断盗血途径,从而进一步提示锁骨下动脉是否存在狭窄以及狭窄程度如何。     

特殊症状的锁骨下动脉盗血综合征及血管内支架治疗

196 0年 Contorni首先报道锁骨下动脉盗血综合征现象 ,196 1年 Fisher把这种现象命名为锁骨下动脉盗血综合征。本病是由于无名动脉或锁骨下动脉分出椎动脉之前的近心段发生部分或完全闭塞时 ,在虹吸作用下 ,患侧椎动脉血液逆流 ,对侧椎动脉血液也部分被盗取过来 ,进入患侧锁骨下动脉供应患侧上肢 ,以致产生椎 -基底动脉缺血和患侧上肢缺血症状。Patel和 Toole对锁骨下动脉盗血综合征的各种表现作了详细阐述 ,但其中没有分水岭梗死和胸前区疼痛为主要症状方面的报道 ,现将我们治疗的两例特殊临床表现的锁骨下动脉盗血综合征报告如下 [1 ]。…     

锁骨下动脉盗血综合征的临床表现与盗血程度及类型的关系

目的应用经颅多普勒超声(TCD)和数字减影血管造影(DSA)分析锁骨下动脉(Sub-A)起始段严重狭窄或闭塞导致的锁骨下动脉盗血综合征(SSS)的盗血程度和类型与椎基底动脉供血不足(VBI)的关系.方法回顾性总结152例经TCD检查诊断的Sub-A严重狭窄或闭塞患者(其中45例进一步行DSA检查).根据同侧椎动脉(Ip-VA)TCD检测的血流方向,将盗血程度分为无盗血(Ip-VA完全正向)、Ⅰ度盗血(Ip-VA收缩期有切迹)、Ⅱ度盗血(Ip-VA收缩期反向,舒张期正向)和完全盗血(Ip-VA完全反向).盗血途径基底动脉参与盗血(基底动脉呈盗血频谱)或不参与盗血两种.根据DSA管径大小将Sub-A狭窄程度区分为50%～74%,75%～95%和闭塞三种情况.结果(1)96例有临床缺血表现,其中VBI占76%,同侧上肢缺血症状占9%,两种症状均有占14%.83%患者两侧收缩压差≥20 mm Hg(1 mm Hg=0.133 kPa),而仅有33%患者舒张压差≥20 mm Hg,两者比较差异有显著意义(P<0.05).(2)45例进一步行DSA检查患者的Sub-A狭窄严重性与椎动脉盗血程度成正比(P<0.05).(3)TCD检查无盗血34.2%,Ⅰ度盗血19.9%,Ⅱ度盗血15.8%, 完全盗血30.1%.VBI与盗血程度无关(P=0.54).152例患者中52例(34.2%)基底动脉参与盗血,基底动脉参与盗血的患者中38例(73%)出现VBI,而基底动脉未参与盗血的患者中只有35例(35%)出现VBI,两者比较差异有显著意义(P<0.05).结论 TCD是诊断SSS敏感可靠的方法,能使更多的临床和临床下患者得到诊断,收缩期血压差较舒张期血压差改变更明显,VBI与盗血程度无关,而与基底动脉参与供血有关.     

锁骨下动脉盗血综合征五例临床分析

目的探讨锁骨下动脉盗血综合征(SSS)的临床特点,提高临床医师对本病的认识,降低误诊率。方法分析2008年至2010年9月我科收治的锁骨下动脉盗血综合征患者5例,就其临床表现、经颅多普勒超声(TCD)、彩色多普勒血流显像(CDFI)、数字减影血管造影(DSA)结果以及治疗预后进行分析。结果 TCD为锁骨下动脉盗血的及早诊断和治疗提供了依据,DSA是确诊锁骨下动脉盗血的金标准。结论锁骨下动脉盗血临床表现多样,易误诊漏诊,确诊依靠DSA。DSA结合临床表现,对诊断SSS和选择治疗方案有重要价值。     

锁骨下动脉、头臂干严重狭窄或闭塞的血流动力学改变及窃血方式

目的探讨锁骨下动脉（SubA）或头臂干（BCAT）严重狭窄或闭塞患者的血流动力学改变及窃血方式。方法对65例经数字减影血管造影或颈动脉彩色多普勒超声证实的SubA起始段或BCAT严重狭窄或闭塞患者行经颅多普勒超声（TCD）和颈动脉连续波多普勒超声（CWD）检测。结果46例狭窄患者中25例检出SubA或BCAT局限性严重狭窄血流。19例闭塞患者未探及到病侧SubA或BCAT血流信号。30例病变远端的SubA、尺动脉和桡动脉血流波形异常，呈低流速低搏动改变；7例病侧桡动脉未探及到血流信号；28例病变远端动脉的高阻力波形仍存在，但与对侧同名动脉比较血流速度和搏动指数减低。所有患者均检出椎动脉-椎动脉窃血，30例有基底动脉-椎动脉窃血，14例有枕动脉-椎动脉窃血，5例BCAT病变患者有前循环窃血。结论TCD和CWD有助于了解SubA或BCAT严重狭窄或闭塞患者的血流动力学改变和窃血方式，为临床确定诊断、寻找椎-基底动脉供血不足的原因和更深入研究缺血性脑血管病的发病机理提供重要的客观依据。     

锁骨下动脉盗血综合征经颅多普勒超声检查临床价值

目的研究锁骨下动脉盗血综合征(SSS)的经颅多普勒超声(TCD)表现,并结合数字减影血管造影(DSA)检查探讨TCD对于SSS的诊断和治疗的临床意义和应用价值。方法分析69例经TCD诊断为SSS患者的血流动力学变化,根据患侧椎动脉(VA)频谱特点将盗血分为Ⅰ、Ⅱ、Ⅲ期盗血。初步判断盗血途径,分为健侧VA和/或基底动脉(BA)参与盗血。其中部分患者(39例)行DSA检查,根据DSA检查结果将锁骨下动脉(SubA)狭窄程度分为轻度狭窄(狭窄程度≤50%)、中度狭窄(狭窄程度51～75%)、重度狭窄(狭窄程度76～95%)和闭塞四组。并将各组检查结果与TCD检查结果进行对照分析研究。结果在TCD检查示Ⅰ期盗血的6例患者中,DSA示SubA轻度狭窄患者3例,中度狭窄3例;TCD检查示Ⅱ期盗血的16例患者中,DSA示SubA中度狭窄患者8例,重度狭窄7例,闭塞1例;TCD检查示Ⅲ期盗血的17例患者中,DSA示SubA中度狭窄2例,重度狭窄8例,闭塞7例。TCD检查所发现的盗血程度与DSA检查发现的SubA狭窄程度呈正相关(r=0.78)。结论 TCD是诊断SSS敏感而可靠的方法,为临床早期诊断和治疗提供了可靠的依据。     

经颅多普勒超声及彩色多普勒超声联合检测在诊断锁骨下动脉盗血综合征中的应用

目的 通过分析锁骨下动脉盗血综合征(SSS)患者经颅多普勒超声(TCD)及彩色多普勒超声(CDU)的检测结果,探讨二者对SSS的诊断价值.方法 SSS患者94例,均经TCD和CDU确诊,且有11例经DSA检查证实.采用德国EME公司的TC-8080经颅多普勒超声及美国GE公司的LOGIQ BOOK彩色多普勒超声.根据同侧椎动脉(Ip-VA)检测的血流方向,将盗血程度分为:I度盗血(Ip-VA收缩期有切迹);II度盗血(Ip-VA舒张期正向,收缩期反向);III度盗血(Ip-VA完全反向).结果 94例SSS患者中多发性动脉硬化88例,大动脉炎6例,其中锁骨下动脉狭窄96条,平均管径为0.9～3.9mm,血流速度范围150～500cm/s,闭塞4条.I度盗血占45%;II度盗血占35%;HI度盗血占20%.基底动脉参与盗血的患者6例,大脑后动脉参与盗血2例.11例行DSA检查患者中,有4例闭塞或几乎闭塞.4例狭窄在75%～95%,3例狭窄在50%～74%.结论 将TCD与CDU相结合不仅可以观察盗血的程度和途径,而且可以明确狭窄的病因及程度,且二者无创、经济、简便,可作为锁骨下动脉盗血综合征的首选检查手段,并可用于评价治疗效果及长期随诊.

Abstract：

Objective By oserving the phenomenon of subclavain steal syndrome(SSS) with Transcranial Doppler ultrasonography (TCD) and Color Doppler ultrasonography ( CDU) ,to analyze the diagnostic value of them in SSS. Methods 94 patients were diagnosed as SSS by TCD and CDU, 11 of them were verified with digital substract angiography ( DSA). Double MCA, ACA,PCA, VA and BA were examined with 2MHz probe of TCD. The lumen and intima-media of carotid, vertebral , subclacian and innominate arteries were displayed with two-dimensional ultrasonography and their blood flow velocity and direction were detected by color and spectral Doppler ultrasonography with LOGIQ BOOK computed sonography. According to the direction of ipsilateral VA (ip-VA ) , the subclavian steal syndrome ( SSS) were defined as stage I ( deceleration in systole) , stage II ( alteration flow with reversed flow in systole and normal flow in diastole) and stage III ( reversed flow completely). The steal pathway was defined as basilar artery steal pathway (with steal waveform in basilar artery ( BA) ) or non-basilar artery steal pathway ( normal direction in BA). Results 88 patients of SSS were caused by atherosclerosis, 6 patients by aortoarteritis. 96 had subclavian arterial stenosis with lumen diameter 0. 9 ～3. 9mm and the velocity 150 ～500cm/s,occlusion of subclavian occurred in 4 patients 45% had steal stage I ,35% had steal stage II ,20% had steal stage III. 6 patients had basilar artery steal pathway and 2 patients had posterior cerebral arteryl steal pathway. Occlusion or nearly occlusion of subclavian were 4 patients with DSA. The severity of subclavain of 4 patients was 75% ～95% and other 3 was 50% ～ 74 %. Conclusion TCD combine with CDU is a sensitive and reliable method for evaluating the steal phenomena in patients with subclavian artery stenosis, they can not only observe the degree and path ways of steal phenomena , but also can indetify the etiopathogensis and severity of stenosis, and they are economic, convenient, no-injured, so they can be the first and foremost dignosis method for SSS, they also can be used to evaluate therapeutic effect and long-term follow-up.     

Hemodynamics of the vertebral artery in subclavian steal syndrome and subclavian steal phenomenon]

To evaluate hemodynamics of the vertebral artery (VA) in subclavian steal syndrome (SSS) and subclavian steal phenomenon (SSP), blood flow velocities of the bilateral VAs were measured by duplex ultrasonography in four patients with SSS and eight patients with SSP. The reversal of flow in the VA was noted in both systolic and diastolic phases in all of the SSS group, and was recorded only in a systolic phase in all but one of the SSP group. The antegrade mean flow velocities in the VA on the unaffected side in the SSS group were significantly higher than those in the SSP group. This indicates that collateral blood flow through the VA in the SSS group is still insufficient to compensate the blood requirement of the upper extremity on the affected side. In conclusion, hemodynamics of the VA in the SSS group could be distinguished from those in the SSP group by duplex ultrasonography.     

Subclavian Steal Syndrome: Can the Blood Pressure Difference Between Arms Predict the Severity of Steal

BACKGROUND AND PURPOSE: A side-to-side difference in systolic brachial arterial blood pressure is a common finding in subclavian artery stenosis and is frequently used as a screening tool for subclavian steal syndrome (SSS). It was the goal of this retrospective study to investigate the relationship between different vertebral artery waveform types and the side-to-side difference in systolic blood pressure in patients with sonographically proven SSS. METHODS: The records of 1860 patients from the Neuroultrasound Laboratory between January 2000 and December 2000 were screened for the diagnosis of SSS in the final ultrasound report. In all patients, bilateral brachial arterial blood pressure was measured in a sitting position prior to the ultrasound examination. Vertebral artery waveforms were classified as (1) systolic deceleration, (2) alternating flow, and (3) complete reversal at rest. Blood pressure difference as calculated by normal-side blood pressure minus lesion-side blood pressure was compared with the 3 Doppler waveform types. RESULTS: SSS was found in 51 of 1860 (2.7%) ultrasonography studies of 49 patients (17 men, 32 women; mean age 65.3 +/- 10.5 years). Two patients (4%) had bilateral SSS. In 3 patients (6%), SSS was related to an innominate artery stenosis. Waveform analysis showed a completely reversed flow in 16 (31%), an alternating flow in 24 (47%), and a systolic deceleration in 11 (22%) cases. Systolic blood pressure difference was significantly higher in the complete reversal and alternating groups than in the systolic deceleration group (P < .001). CONCLUSION: Brachial systolic blood pressure difference is related to the severity of SSS and can be used as a screening tool for SSS. However, it performed better in severe steal than milder steal phenomena.     

青年与老年椎动脉型颈椎病的临床研究及其意义

目的 分析探讨青、老年椎动脉型颈椎病的临床特点和不同的发病机制。方法 对青年组(58例)、老年组(96例)患者的临床表现、颈椎X线、经颅彩色多普勒超声(TCD)、脑电图(EEG)、治疗及预后进行对比分析。结果①颈椎X线:老年组以椎间隙变窄、骨质增生、软组织钙化为著(P<0.025);青年组以曲度不自然为著(P<0.025)。②TCD检查:老年组显示左侧椎动脉的收缩峰期血流速度和基底动脉的平均血流速度明显缓慢(P<0.05),提示有动脉狭窄;青年组的血流速度快,提示有血管痉挛。③青年组的治疗和预后明显较老年组好(P<0.005)。④两组临床表现和脑电图无明显差异。结论 青、老年椎动脉型颈椎病患者发病存在不同的病理机制,应区别对待;青年患者以曲度变直、神经根易激惹、血管痉挛为主,应及时纠正不良工作习惯,减少神经根刺激;老年患者椎间隙狭窄、骨质钙化增生压迫神经,神经根激惹轻,以动脉狭窄为主,治疗效果差,易复发,应采取牵引、理疗等综合治疗。     

Transcranial Doppler ultrasonographic evaluation of vertebral artery hypoplasia and aplasia

BACKGROUND AND PURPOSE: Evaluation of vertebral artery (VA) with transcranial Doppler ultrasonography (TCD) is difficult due to anatomical variations of hypoplasia (HP) or aplasia (AP). TCD findings of HP or AP of VA are rarely known. Comparing with magnetic resonance angiography (MRA), we tried to evaluate characteristic findings of HP or AP of VA using TCD. METHODS: Consecutive healthy patients who underwent TCD and MRA were included. VA was classified as normal (NL), hypoplasia (HP), and aplasia (AP) according to MRA. TCD parameters of mean flow velocity (MFV), pulsatility index (PI), vertebral/basilar artery flow velocity ratio (VA/BA FVR), and asymmetry index (AI) of VA were compared between three groups. RESULTS: Four hundred and ten patients were included, and 298 patients (72.7%) were classified as NL, 98 (23.9%) as HP and 14 (3.4%) as AP. MFV, PI and VA/BA FVR of ipsilateral VA were not different between groups. However, MFV of contralateral VA and AI were significantly increased in HP and AP groups (p<0.001). AI was significantly different between the three groups (17.7% and 30.5%, p<0.001). Sensitivity and specificity for HP or AP were 20.5% and 90.9%, if AI over 40% were adopted as diagnostic criteria. CONCLUSION: MFV of VA should be interpreted with caution for its frequent anatomical variations. Increased MFV of unilateral VA may indicate not only as ipsilateral stenosis, but also as contralateral HP or AP. AI over 40% is specific to predict unilateral HP or AP with clinical correlation.     

TCD对糖尿病患者基底动脉血流动力学变化的检测

目的应用经颅多普勒超声(TCD)观察81例糖尿病患者的基底动脉(BA)血流动力学变化。方法将81例糖尿病患者TCD检测结果与90例高血压患者进行对照。结果糖尿病组BA的血流增快稍低于MCA,高血压组BA的血流增快则明显低于MCA,2组相比糖尿病组BA的血流增快明显高于高血压组,而且糖尿病组BA的频谱和音频异常率不仅明显高于高血压组的同名动脉,也高于同组的MCA和VA。结论对糖尿病和非糖尿病患者的TCD检测有助于及早发现隐性糖尿病,预防糖尿病患者发生缺血性脑血管病。     

PET和TCD对阿耳茨海默病早期诊断的研究

目的 利用正电子发射计算机断层扫描（ｐｏｓｉｔｒｏｎ ｅｍｉｓｓｉｏｎ ｔｏｍｏｇｒａｐｈｙ,ＰＥＴ）和经颅多普勒超声（ｔｒａｎｓｃｒａｎｉａｌ ｄｏｐｐｌｅｒ,ＴＣＤ）相结合的方法探讨阿耳茨海默病（Ａｌｚｈｅｉｍｅｒ’ｓ ｄｉｓｅａｓｅ,ＡＤ）的早期诊断,以及ＡＤ与脑血液供应之间的关系。方法 ２０例可疑ＡＤ患者和２０例正常对照行ＰＥＴ、ＴＣＤ以及临床神经心理量表检查,对局部脑区葡萄糖代谢率（ｒｅ