冠状动脉-锁骨下动脉窃血综合征经皮腔内治疗效果的初步探讨  

Effectiveness of endovascular therapy for coronary-subclavian steal syndrome

作　　者：刘亚军[1,2] 王迪[3] 赵卫东[1] 甘泉[1] 赵国珍[1] 张建[2] 

机构地区：[1]河北省秦皇岛市第一医院心血管外科,河北秦皇岛066000 [2]首都医科大学宣武医院血管外科,北京100053 [3]河北省秦皇岛市第一医院内分泌二科,河北秦皇岛066000

出　　处：《河北医科大学学报》2015年第12期1389-1392,共4页Journal of Hebei Medical University

基　　金：卫生部卫生行业科研专项项目(201302008)

摘　　要：目的观察经皮锁骨下动脉腔内成形术预防和治疗冠状动脉-锁骨下动脉窃血综合征导致心肌缺血的临床效果。方法将明确诊断且实施治疗的11例冠心病合并锁骨下动脉闭塞症患者分为2组:A组(n=4)为行冠状动脉移植术前被诊断,同侧乳内动脉拟为移植血管材料,在冠状动脉搭桥术前行锁骨下动脉腔内支架术;B组(n=7)为冠状动脉-锁骨下动脉窃血综合征在冠状动脉旁路移植术后被诊断,确诊后实施经皮穿刺血管成形支架术。所有患者出院后第3、6、12个月时及此后每年1次随访复查。结果 10例成功实施腔内支架手术,B组中1例再通失败接受了颈动脉-锁骨下动脉旁路术;A组4例成功实施冠状动脉搭桥手术且随访均血流通畅,B组6例支架术后造影均恢复正向血流且心绞痛症状完全消失。随访A组中1例术后第72个月死于肺癌,终止随访时未发生支架再狭窄;B组中1例发生>50%的再狭窄,但无明显心肌缺血或锁骨下动脉窃血相关症状。结论经皮腔内锁骨下动脉血管成形支架术可以避免冠状动脉-锁骨下动脉窃血综合征发生,而且也是安全有效的治疗措施,具有良好的中远期开放率。Objective To evaluate whether percutaneous subclavian artery angioplasty and stent can be used as prevention and treatment of coronary-subclavian steal syndrome.MethodsBetween May 2007 and February 2015,10 stents were placed in 11 patients who underwent endovascular therapy for the prevention（group A,n=4）or treatment（group B,n=7）of coronarysubclavian steal syndrome.All patients were followed 6,12 months after treatment and annually thereafter.Results Technical success was achieved in 10 patients,one patient（group B）failed to bypass the occlusion.The symptoms before therapy were sucsussed to resolve in all patients.Recurrent obstruction（〉50%）developed in one patient（group B）without significant symptoms.No complications were observed in all patients.One patient（group B）died due to lung cancer after hospital discharge.Conclusion Endovascular therapy with stent placement can be used as safe and effective prevention and treatment for coronary-subclavian steal syndrome.

关 键 词：冠脉-锁骨下动脉窃血综合征 血管成形术 治疗结果 

分 类 号：R654.4[医药卫生—外科学]