经皮血管内成形术治疗锁骨下动脉盗血综合征的疗效观察  

Percutaneous transluminal angioplasty of the subclavian steal syndrome:a long-term follow-up

作　　者：高山[1] 黄一宁[1] 金征宇[2] 汪波[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院神经内科,100730 [2]中国医学科学院中国协和医科大学北京协和医院放射科,100730

出　　处：《中华神经科杂志》2000年第4期38-40,64,共4页Chinese Journal of Neurology

摘　　要：目的　观察经皮血管内成形术 (PTA)治疗锁骨下动脉盗血综合征 (SSS)的近期和远期疗效。方法　有症状SSS患者 15例 ,全部为男性 ,平均年龄 5 9岁 (43～ 75岁 )。椎基底动脉供血不足 6例 ,患肢缺血 3例 ,两组症状兼有 6例。 13例经股动脉、2例经腋动脉行狭窄部位球囊扩张术 (右侧 7例 ,左侧 8例 ) ,术中及术后给予抗凝治疗。全部患者术前后均行脑血管造影 (DSA)和经颅多谱勒超声检查 (TCD) ,术后每半年或病情有变化时复查TCD。结果　术前DSA检查狭窄均大于 85 % ,椎动脉逆行显影 10例 ,显影淡 5例。扩张后 13例残余狭窄 <30 % ,1例接近 5 0 % ,另 1例因反复缩窄行支架置入术 ,术后椎动脉均正向显影良好。术前全部患者TCD均测到反向血流 ,术后除 1例有反向血流外 ,其余均为正向血流。术前患健侧收缩压差 (43± 14)mmHg ,术后为 (9± 6 )mmHg。 3例出现轻度并发症。平均随诊 2 5个月 (11～ 6 5个月 ) ,2例分别于术后 1和 8个月时复发。结论　PTA是治疗SSS安全有效的方法 ,长期应用抗凝及抗血小板治疗能取得理想的远期疗效 ,TCD可作为常规的随诊手段。Objective To analyze the early and late results of percutaneous transluminal angioplasty (PTA) of the subclavian steal syndrome (SSS). Methods Fifteen patients ranged in age from 43 to 75 years with a mean of 59 years. The primary clinical indications were vertebrobasilar insufficiency in 6 patients, upper limb ischemia in 3 patients and both types of symptoms in 6 patients. PTA was attempted on the left side in 8 patients and on the right side in 7 patients. They received anticoagulant during and after the study. Follow up study with transcranial Doppler ultrasound (TCD) was used. Results The reversed flows of the vertebral artery (VA) were found in 10 of 15 performed by DSA and in all patients by TCD. The residual lumen was less then 30% in 13 patients, 50% in one and the reversed flow of VA was not found in all patients performed with DSA after PTA. TCD showed that the flow direction of VA was normal in all the patients except one. 12 patients on follow up over 11～65 months with a mean of 25 months were free of symptoms. Two patients showed relapses after 1 month and 8 months, respectively. Three minor complications occurred. Conclusion PTA appeared safe and efficient for the therapy of subcalvian steal syndrome with satisfactory short and long term results.

关 键 词：锁骨下动脉窃血综合征 血管成形术 超声检查 多谱勒 经颅 

分 类 号：R442.8[医药卫生—诊断学]