TCD检测无名动脉狭窄并双通道窃血2例并文献复习  

Two cases of innominate artery stenosis with double channel steal detected by TCD and literature review

作　　者：张雪桦 宋敏 丁晓君 姜晓晗 张永庆 ZHANG Xuehua;SONG Min;DING Xiaojun;JIANG Xiaohan;ZHANG Yongqing(Department of Neurology,Qilu Hospital(Qingdao),Cheeloo College of Medicine,Shandong University,Qingdao 266035,Shandong,China)

机构地区：[1]山东大学齐鲁医院(青岛)神经内科,山东青岛266035

出　　处：《山东大学学报（医学版）》2022年第12期101-106,共6页Journal of Shandong University:Health Sciences

摘　　要：目的 总结无名动脉(IA)极度狭窄/闭塞引起椎动脉系统及颈动脉系统血流动力学变化的特点,并进行鉴别诊断。方法 分析2例IA极度狭窄患者的经颅多普勒超声(TCD)检查结果,以及其引起椎动脉系统及颈动脉系统窃血的频谱特点,并复习相关文献报道。结果 病例1患者男性,77岁,右上肢收缩压比对侧低51 mmHg,全麻术前行TCD检查提示IA极度狭窄/闭塞,并存在两条窃血通路:(1)基底动脉(BA)→右侧椎动脉(VA);(2)左侧大脑前动脉(ACA)→右侧ACA→右侧颈内动脉末端(TICA)→右侧颈总动脉(CCA)。颈动脉CTA示IA夹层形成并极度狭窄。病例2患者女性,76岁,右上肢收缩压比对侧低34 mmHg, TCD检查提示IA极度狭窄/闭塞,并存在两条窃血通路:(1)左侧椎动脉(LVA)→右侧椎动脉(RVA);(2)左侧大脑前动脉(LACA)→右侧大脑前动脉(RACA)→右侧大脑中动脉(RMCA)。颈动脉磁共振血管成像(MRA)提示IA闭塞。结论 IA极度狭窄/闭塞会引起双侧脑血管压力不平衡而出现窃血现象,TCD能敏感地检测出窃血通路。当右侧颈总动脉(RCCA)出现低平圆钝频谱、窃血频谱或检测不到血流信号,且RVA出现窃血频谱时,要警惕IA极度狭窄/闭塞可能。Objective To summarize the characteristics of hemodynamic changes in vertebral artery system and carotid artery system caused by innominate artery(IA) steno-occlusion, and to make differential diagnosis. Methods The results of transcranial Doppler ultrasonography(TCD) and spectral characteristics of vertebral artery system and carotid artery system steal in two patients with extreme IA steno-occlusion were analyzed. Relevant literature was reviewed. Results Case 1 was a 77-year-old male whose right upper extremity systolic blood pressure was 51 mmHg lower than the other side. Before general anesthesia, TCD showed extreme steno-occlusion of IA and two steal pathways, including basilar artery(BA) → vertebral artery(VA), and left anterior cerebral artery(ACA) → right ACA→ terminal internal carotid artery(TICA) → right common carotid artery(CCA). CTA demonstrated a dissection and extreme narrowing in the IA. Case 2 was a 76-year-old female whose lower right upper extremity systolic blood pressure was 34 mmHg lower than the other side. TCD revealed extreme steno-occlusion of IA and two steal pathways, including left vertebral artery(LVA)→right vertebral artery(RVA), and left arteriae cerebri anterior(LACA) →right arteriae cerebri anterior(RACA)→right middle cerebral artery(RMCA). Carotid MRA suggested occlusion in IA. Conclusion IA steno-occlusion may cause bilateral cerebrovascular pressure imbalance and lead to the occurrence of steal. TCD can be sensitive to detect the steal pathways. When RCCA shows low and round, or steal spectrum, or there is no blood flow signal, and when RVA shows steal spectrum, extreme IA steno-occlusion should be suspected.

关 键 词：无名动脉极度狭窄 无名动脉闭塞 窃血现象 窃血通路 经颅多普勒超声 

分 类 号：R743.3[医药卫生—神经病学与精神病学]