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  • Title: [Subclavian artery stenosis combined with vertebral artery stenosis may lead to compensatory blood flow changes in the contralateral vertebral artery].
    Author: Liang Y, Qiu L, Xie J.
    Journal: Nan Fang Yi Ke Da Xue Xue Bao; 2018 Dec 30; 38(12):1509-1513. PubMed ID: 30613022.
    Abstract:
    OBJECTIVE: To investigate the severity of blood steal and the hemodynamic profiles in patients with subclavian artery stenosis combined with vertebral artery stenosis. METHODS: A retrospective analysis was performed of transcranial Doppler (TCD) data from patients with subclavian artery stenosis (SAS) and concomitant unilateral/bilateral vertebral artery stenosis (VAS, >50%) or occlusion in our institution between February, 2014 and July, 2018.Thirty-seven patients with SAS combined with VAS (SAS+VAS) were reviewed for types of blood steal, peak systolic velocities of blood flow in affected subclavian artery and the contralateral vertebral artery, and the findings of hyperemia testing.These data were also reviewed for 39 SAS patients without VAS (control group) for comparison of blood steal and hemodynamic profiles. RESULTS: In SAS+VAS group, 5 patients showed no blood steal; blood steal in stage Ⅰ was found in 22 patients, stage Ⅱ in 7, and stage Ⅲ in 3, as compared to the numbers of 17, 12 and 10 in the control group, respectively (H=9.431, P=0.002).The peak systolic velocity of the contralateral vertebral artery was 43.91±17.43 cm/s in SAS+VAS group, significantly lower than that in the control group (53.56±17.45 cm/s; t= 629.5, P=0.006).Hyperemia testing showed a significant difference in the negative rate between SAS+VAS group and the control group[35.1%(13/37) vs 7.7%(3/39);χ2=8.603, P=0.003). CONCLUSIONS: SAS combined with VAS may lead to reduced compensatory blood flow in the contralateral vertebral artery to lessen the severity of subclavian steal syndrome. 目的: 探讨锁骨下动脉狭窄合并椎动脉狭窄性病变的盗血程度及血流动力学情况。 方法: 回顾性分析2014年2月~2018年7月合并单侧或双侧椎动脉狭窄(狭窄程度大于50%)或闭塞的锁骨下动脉狭窄患者(合并椎动脉狭窄性病变组, 37例)的经颅多普勒超声资料, 总结其盗血类型、病变锁骨下动脉收缩期峰值流速、对侧椎动脉收缩期峰值流速及束臂试验结果, 以无合并椎动脉狭窄性病变的锁骨下动脉狭窄患者为对照组(39例), 比较各组间盗血程度及血流动力学的差异。 结果: 合并椎动脉狭窄性病变组盗血情况如下:无盗血5例, Ⅰ期22例, Ⅱ期7例, Ⅲ期3例。对照组:Ⅰ期17例, Ⅱ期12例, Ⅲ期10例。两组盗血程度比较差异有统计学意义(H=9.431, P=0.002)。合并椎动脉狭窄性病变组的对侧椎动脉收缩期峰值流速为43.91±17.43 cm/s。与对照组53.56±17.45 cm/s相比差异有统计学意义(t=629.5, P=0.006)。合并椎动脉狭窄性病变组的束臂试验阴性率为35.1% (13/37), 对照组的束臂试验阴性率为7.7%(3/39), 两组比较差异有统计学意义(χ2=8.603, P=0.003)。 结论: 锁骨下动脉狭窄合并椎动脉狭窄性病变可导致对侧椎动脉代偿血流减少, 锁骨下动脉盗血程度减轻。
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