血管内治疗以头晕起病的锁骨下动脉盗血综合征24例并文献复习  

Intravascular treatment of 24 cases of subclavian steal syndrome caused by dizziness and literature review

作　　者：陈芸 张硕 杜汉军[1] CHEN Yun;ZHANG Shuo;DU Hanjun(Department of Neurology,Peking University Shougang Hospital,Beijing 100041,China;Department of Neurology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学首钢医院神经内科,北京100041 [2]北京大学人民医院神经内科,北京100044

出　　处：《中国医药科学》2024年第4期191-195,共5页China Medicine And Pharmacy

摘　　要：目的探讨头晕起病的锁骨下动脉盗血综合征(SSS)的临床特征、血管内治疗方案、效果及注意事项。方法回顾北京大学首钢医院2021年7月至2023年1月收治的头晕起病的24例SSS患者的一般特征、临床表现、经颅多普勒超声(TCD)、头颈CT血管造影成像(CTA)、数字减影血管造影成像(DSA)等相关临床资料数据及其锁骨下动脉内治疗情况,分析血管内支架置入的治疗效果。复习相关文献,以提高对SSS的识别及诊断治疗经验。结果24例患者中左侧锁骨下动脉重度狭窄13例,左侧锁骨下动脉闭塞2例,右侧锁骨下动脉重度狭窄9例,成功置入病变处23枚支架,术中造影可见椎动脉恢复正向血流,术后患侧上肢脉搏、血压恢复,患者头晕改善,复查TCD未再出现锁骨下动脉盗血现象。血管内治疗失败1例,究其原因与患者既往主动脉弓覆膜支架介入治疗相关。结论以头晕为临床表现的锁骨下动脉狭窄,常提示锁骨下动脉盗血。锁骨下动脉支架置入治疗SSS能快速有效缓解临床症状且安全有效。Objective We aimed to explore the clinical characteristics,intravascular treatment plans,effects,and precautions of subclavian steal syndrome(SSS)caused by dizziness.Methods We conducted a retrospective study on the general characteristics,clinical manifestations,transcranial doppler(TCD),head and neck CT angiography(CTA),digital subtraction angiography(DSA),and other relevant data,as well as intravascular treatment of 24 patients with SSS caused by dizziness admitted to Peking University Shougang Hospital from July 2021 to January 2023.The efficacy of intravascular stent placement was analyzed.The relevant literature was reviewed to improve understanding and experience in the diagnosis and treatment of SSS.Results Among the 24 patients,there were 13 cases of severe stenosis of the left subclavian artery,2 cases of occlusion of the left subclavian artery,and 9 cases of severe stenosis of the right subclavian artery.23 stents were successfully placed at the lesion site.Intraoperative angiography showed that the vertebral artery restored positive flow,and the pulse and blood pressure of the affected upper limb recovered after the operation.The patient’s dizziness improved,and there was no further evidence of subclavian steal syndrome on the reviewed TCD.1 case failed the intravascular treatment,and the cause is related to the patient’s previous aortic arch stent graft intervention treatment.Conclusion Subclavian artery stenosis characterized by dizziness often indicates subclavian artery steal.Intravascular stent placement for the treatm ent of SSS can effectively alleviate clinical s ymptoms and is safe and effective.

关 键 词：血管内治疗 锁骨下动脉狭窄 锁骨下动脉盗血综合征 头晕 

分 类 号：R543.5[医药卫生—心血管疾病]