锁骨下动脉狭窄经皮介入治疗152例分析

Procedural success rate and short-term outcomes of percutaneous interventional therapy for severe subclavian artery stenosis in 152 patients

目的评估经皮血管成形术治疗锁骨下动脉狭窄的安全性及近-中期疗效。方法连续152例住院患者,男88例,女64例,年龄17～82(58±16)岁,共179条(单侧125例,双侧27例)锁骨下动脉严重狭窄(直径狭窄70%～100%),病因分别为动脉粥样硬化114例(75%)和大动脉炎38例(25%),因患侧上肢间歇性运动无力130例(85.5%),锁骨下动脉窃血138例(90.8%),冠状动脉窃血综合征2例(1.8%),蓝指综合征2例(1.8%),或准备用患侧乳内动脉旁路移植的无症状患者10例(6.6%),经股动脉(n=96)、肱动脉(n=25)或桡动脉(n=3)和联合(n=28)路径行经皮血管成形术,并随诊9个月观察手术的疗效。结果 133处狭窄性病变(直径狭窄70%～99%)经皮血管成形术均获成功(100%),46处完全闭塞性病变中36处经皮血管成形术成功(78.2%)。其中145处病变因单纯球囊成形结果不够满意而置人支架。经皮血管成形术成功后病变狭窄程度从术前的(90±8)%降至(5±8)%,病变动脉直径从术前的(1.0±0.9)mm 升至(7.0±0.5)mm(P 值均<0.0001)。未发生严重的并发症。经皮血管成形术成功的142例患者术后随访9个月,其中135例患者血管通畅,疗效稳定,另有7例发生再狭窄,其中4例为大动脉炎患者,3例为动脉粥样硬化患者。结论经皮血管成形术治疗锁骨下动脉狭窄安全,近-中期疗效好,远期疗效有待进一步调查。

Objective To evaluate the safety and efficacy of percutaneous transluminal angioplasty （PTA, with or without stents） for the treatment of patients with subclavian artery stenosis. Methods Using the brachial （ n = 25 ） , radial （ n = 3 ） , femoral （ n = 96 ） , or combined （ n = 28 ） approach, PTA was performed in consecutive 152 [ bilateral n=27, unilateral n = 125, 88 male, aged 17～82 （58 ± 16 ）years old] subclavian artery stenosis patients with 179 lesions. Stenosis was caused by atheroma in 114 of 152 patients （75%） and by aortoarteritis in the other patients （25%）. The indications for intervention were arm claudication in 130 of 152 patients （ 85.5% ）, subclavian steal in 138 of 152 patients （ 90. 8% ）, blue finger syndrome in 2 of 152 patients（ 1.3% ）, coronary steal syndrome in 2 of 162 patients（ 1.3% ）, or anticipated coronary artery bypass grafting using the internal mammary artery in 10 asymptomatic patients （6. 6% ）. All patients were followed up for at least 9 months after procedure. Results PTA was succeeded in 142 of 152 patients （93.4%）and procedural success rate was 100% in 133 stenotic lesions （diameter reduction 70% ～99% ） and 78. 2% in total occlusive lesions （36/46）. Stents were deployed in 145 of 169 lesions. In the 142 patients successfully treated with PTA, the percent diameter stenosis was reduced from （90 ± 8） % to （6 ± 8 ） % , and lesions diameter improved from （ 1.0 ± 0. 9） mm to （7.0 ± 0. 5 ） mm （ all P values 〈 0. 001）. No severe procedure related complications were observed. During 9 months follow-up in these 142 patients with successful PTA, sustained clinical improvement was seen in 135 patients and restenosis occurred in 7 patients with aortoarteritis （ n = 4 ） and atheroma （ n = 3 ） . Conclusions Percutaneous transluminal angioplasty is effective and safe for the treatment of subclavian artery stenosis.