锁骨下动脉盗血综合征的经颅多普勒和血管造影分析

Study of subclavian steal syndrome with TCD and DSA

用经颅多普勒超声（ＴＣＤ）和血管造影（ＤＳＡ）检查了１３例锁骨下动脉盗血综合征病人，ＴＣＤ发现１１例有椎动脉血流反向，肢体功能试验时反向血流增加。２例血流方向正常，功能试验血流方向倒转或血流速度下降。１例无名动脉狭窄，右侧椎动脉和颈总动脉均受累，出现大脑中动脉盗血。ＤＳＡ显承５４％的病人有反向血流。提示椎动脉反向血流与锁骨下动脉狭窄程度和侧支循环建立程度有关。２５％同时合并大脑中动脉狭窄。ＴＣＤ是观察椎动脉、基底动脉、大脑中动脉盗血的敏感方法，可帮助判断其对大脑半球血液供应的影响。

Thirteen cases of subclavian steal syndrome were studied with TCD and DSA. 11 cases were found to have reversal flow of the vertebral artery with increased flow velocity during the functional test of the involved upper limb. Two cases were found to have normal direction of flow, but in the functional test of the involved upper limb, the flow velocity was decreased in one case and the direction of flow turned from normal to reverse in the another case.The steal phenomenon of blood flow in the middle cerebral artery was noticed in one case coexited with occlusion of right commen carotid artery. DSA showed delayed reversed flow of the vertebral artery in 54%.It suggests that TCD is sensitive to detect the steal phenomenon of subclavian artery and intracranial arteries. Twenty-five percent of the patients from our series were associated with stenosis of middle cerebral artery.