锁骨下动脉窃血综合征的再认识及血管内治疗

目的 研究评价经皮血管内成形及支架置入术治疗锁骨下动脉窃血综合征(SSS)的疗效和安全性.方法 对2007年1月至2009年12月的32例左侧SSS患者进行介入治疗,术前行数字减影血管造影(DSA)检查和评估、抗血小板药物准备,然后实施球囊扩张+支架置入术,同时注意术中抗凝及术后处理,分别于术后即刻、3、6个月随访复查经颅多普勒超声(TCD)评价其疗效.结果 32例患者术前DSA检查结果显示锁骨下动脉狭窄平均为87.5%,术后降为15.0%,术后TCD检查结果显示椎动脉反向血流消失,放置的支架均无回缩和移位.术前患、健侧收缩压差平均为51.6 mmHg(1 mmHg=0.133 kPa),术后3个月时降为10 mmHg,无栓塞及死亡事件发生.结论 球囊扩张+支架置入术是治疗SSS的首选治疗手段,术后抗凝和抗血小板至关重要,TCD随访简易、安全、有效、可靠.

The recognition and endovascular treatment of subclavian steal syndrome

Objective To investigate and evaluate the effectiveness and safety of the percutaneous transluminal angioplasty (PTA) and stent placement (SP) in the treatment of left subclavian steal syndrome (SSS). Methods From January 2007 to December 2009,32 patients with left SSS were selected and the digital substracted angiography (DSA) were used to evaluate before PTA and SP. Anticoagulation and antiplatelet therapy before and after interventional treatment were taken. Then the therapeutic effect was evaluated after the procedure immediately, in the third month and the sixth month post-operatively by transcranial doppler sonography (TCD). Results DSA was used to evaluate therapeutic effect after PTA and SP,the stenosis degree in average lumens diameter of the patients descended from 87. 5% to 15.0%. The stenosis of subclavian steal artery was obviously improved and the contraflow of vertebral artery was disappeared without the stent's recovery and displacement by TCD. The mean systolic blood pressure difference between left and right upper limb was obvious lower than that before therapy 51.6 mmHg (1 mmHg =0. 133 kPa) vs 10 mmHg after 3 months]. No embolism and death was found. Conclusions PTA and SP are effective in the treatment of SSS. Anticoagulation and antiplatelet therapy after interventional treatment has a good therapeutic effect. TCD is a cheap, sensitive and non-invasive method for evaluating SSS.