锁骨下动脉狭窄经皮介入治疗152例分析

目的评估经皮血管成形术治疗锁骨下动脉狭窄的安全性及近-中期疗效。方法连续152例住院患者,男88例,女64例,年龄17～82（58±16）岁,共179条（单侧125例,双侧27例）锁骨下动脉严重狭窄（直径狭窄70％～100％）,病因分别为动脉粥样硬化114例（75％）和大动脉炎38例（25％）,因患侧上肢间歇性运动无力130例（85．5％）,锁骨下动脉窃血138例（90．8％）,冠状动脉窃血综合征2例（1．8％）,蓝指综合征2例（1．8％）,或准备用患侧乳内动脉旁路移植的无症状患者10例（6．6％）,经股动脉（n=96）、肱动脉（n=25）或桡动脉（n=3）和联合（n=28）路径行经皮血管成形术,并随诊9个月观察手术的疗效。结果133处狭窄性病变（直径狭窄70％～99％）经皮血管成形术均获成功（100％）,46处完全闭塞性病变中36处经皮血管成形术成功（78．2％）。其中145处病变因单纯球囊成形结果不够满意而置入支架。经皮血管成形术成功后病变狭窄程度从术前的（90±8）％降至（5±8）％,病变动脉直径从术前的（1．0±0．9）mm升至（7．0±0．5）mm（P值均〈0．0001）。未发生严重的并发症。经皮血管成形术成功的142例患者术后随访9个月,其中135例患者血管通畅,疗效稳定,另有7例发生再狭窄,其中4例为大动脉炎患者,3例为动脉粥样硬化患者。结论经皮血管成形术治疗锁骨下动脉狭窄安全,近一中期疗效好,远期疗效有待进一步调查。

Procedural success rate and short-term outcomes of percutaneous interventional therapy for severe subclavian artery stenosis in 152 patients

OBJECTIVE: To evaluate the safety and efficacy of percutaneous transluminal angioplasty (PTA, with or without stents) for the treatment of patients with subclavian artery stenosis. METHODS: Using the brachial (n = 25), radial (n = 3), femoral (n = 96), or combined (n = 28) approach, PTA was performed in consecutive 152 bilateral n = 27, unilateral n = 125, 88 male, aged 17 approximately 82 (58 +/- 16) years old] subclavian artery stenosis patients with 179 lesions. Stenosis was caused by atheroma in 114 of 152 patients (75%) and by aortoarteritis in the other patients (25%). The indications for intervention were arm claudication in 130 of 152 patients (85.5%), subclavian steal in 138 of 152 patients (90.8%), blue finger syndrome in 2 of 152 patients (1.3%), coronary steal syndrome in 2 of 162 patients (1.3%), or anticipated coronary artery bypass grafting using the internal mammary artery in 10 asymptomatic patients (6.6%). All patients were followed up for at least 9 months after procedure. RESULTS: PTA was succeeded in 142 of 152 patients (93.4%) and procedural success rate was 100% in 133 stenotic lesions (diameter reduction 70% approximately 99%) and 78.2% in total occlusive lesions (36/46). Stents were deployed in 145 of 169 lesions. In the 142 patients successfully treated with PTA, the percent diameter stenosis was reduced from (90 +/- 8)% to (6 +/- 8)%, and lesions diameter improved from (1.0 +/- 0.9) mm to (7.0 +/- 0.5) mm (all P values < 0.001). No severe procedure related complications were observed. During 9 months follow-up in these 142 patients with successful PTA, sustained clinical improvement was seen in 135 patients and restenosis occurred in 7 patients with aortoarteritis (n = 4) and atheroma (n = 3). CONCLUSIONS: Percutaneous transluminal angioplasty is effective and safe for the treatment of subclavian artery stenosis.