锁骨下动脉闭塞症合并椎动脉病变的临床观察

Clinical observation of subclavian arteriosclerosis obliterans combined with severe vetebral artory lesions

目的探讨椎动脉病变对锁骨下动脉闭塞症的窃血程度及临床表现的影响。方法回顾性分析2000年至2012年合并一侧或双侧椎动脉狭窄(狭窄程度大于70%)的锁骨下动脉闭塞症患者(椎动脉病变组,42例)的临床资料,总结该组患者的窃血类型、侧支循环及临床症状特征;以不合并椎动脉病变的锁骨下动脉闭塞症患者为对照(113例,对照组),分析比较椎动脉病变与否对窃血程度及后循环缺血症状的影响。结果椎动脉病变组:无窃血14例,Ⅰ型4例,Ⅱ型17例,Ⅲ型7例;对照组:Ⅰ型2例,Ⅱ型13例,Ⅲ型98例,两组窃血类型比较差异有统计意义(P<0.05)。合并对侧椎动脉病变组有脑缺血症状患者占89.5%(17/19),对照组有脑缺血症状者占63.7%(72/113),两组比较差异有统计意义(P<0.05)。结论椎动脉闭塞性病变可影响锁骨下动脉闭塞症的窃血程度及临床表现。

Objective To investigate the effect of vertebral artery occlusive disease on steal level of patients with subclavian arterial occlusive disease and their clinical symptom.Methods The data of 42 patients(vertebral artery lesion group) with the subclavian arterial occlusiove disease combined with unilateral or bilateral vertebral artery stenosis(stenosis degree>70%)between 2000 and 2012 were analyzed retrospectively. Steal type, collateral circulation and clinical sympotom of patients were reviewed. Compared with control group(113 cases),who suffered from the subclavian arterial occlusion without vertebral artery stenosis, the effect of vertebral artery stenosis on the subclavian arterial steal degree and posterior circulation ischemia symptoms was studied.Results In the vertebral artery lesions group, there were 14 cases wihout steal phenomenon, 4 cases with type I steal ,17 cases with type Ⅱ steal , 7 cases with type Ⅲsteal. In the control group, there were 2 cases with type I steal ,13 cases with typeⅡsteal , 98 cases with typeⅢsteal. And the differences of steal type between the two groups were statistically significant(P<0.05). In the vertebral artery lesions group, 89.5%(17/19)of patients with the subclavian arterial occlusiove disease combined with contralateral vertebral artery stenosis suffered from cerebral ischemia, but cerebral ischemia occurred in 63.7%(72/113)cases in the control group. And the differences of cerebral ischemia rate between the two groups were statistically significant(P<0.05).Conclusion For the patient with the subclavian arterial occlusive disease,vertebral artery occlusive disease can affect the degree of steal and clinical symptom.