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。

The application value of Transcranial Dopppler ultrasonography in diagnosis and following up of subclavain steal syndrome

Objective To observe the performance of subclavian steal syndrome（SSS）and the vertebrobasilar artery flow dynamic changes before and after intravascular stenting with transcranial Doppler ultrasonography（TCD）,to evaluate the application value of TCD in SSS.Methods Totally 94 patients with SSS diagnosed by TCD were studied.All of them were performed with color Doppler flow imaging（CDFI）,11 of them validated by digital substract angiography.15 patients were fol-lowed up for 6 to 18 months with TCD.Results ① Among the 94 patients,65 had symptoms（58 with veterbralbasilar was-chemic,6 with ischemic symptom on ipsilateral arm and 1 with stomach pain）,29 were symptomless.②45% had steal stage Ⅰ,35% had steal stageⅡ,20% had steal stage Ⅲ.6 patients had basilar artery steal pathway and 2 patients had posterior cerebral artery steal pathway.5 patients had steal stage Ⅲ in intracranial VA,but had steal stageⅡ in extracranial VA.③Af-ter following-up of 15 patients,1 suffered degree aggravated and another 1 had new artery steal pathway.4 patients of steal stageⅢ showed that blood flowed from oppsite side VA reverse to Ip-VA until then to Ip-subclavain with DSA,and other 7 patients of steal stageⅠorⅡ showed the blood flowed of Ip-VA slightly indifferent or nomal with DSA.4 patients had in-travascular stenting and were followed up in the 18th month.None of them recured in clinical performance,but 2 of them re-curred in angiography.Conclusion ① TCD is a sensitive and reliable method for evaluating the steal phenomena in patients with subclavian artery stenosis,then also can used to observe and analyze the hemodynamics of basilar artery and posterior cerebeal artery.②TCD is one of the economic,convenient,no-injured and accurate methods to evaluate therapeutic effect and long-term follow-up.