介入治疗左锁骨下动脉盗血6个月效果分析

Analysis of the effectiveness of the interventional therapy for left subclaviansteal syndrome

目的观察支架置入及球囊扩张治疗锁骨下动脉盗血的短期效果。方法对2005-2007年收入我科的24例左侧锁骨下动脉盗血患者实施支架置入+球囊扩张术,分别于术后、3个月、6个月复查经颅多普勒(TCD)评价其疗效。结果术前锁骨下动脉狭窄均>85%,椎动脉逆行显影19例,淡影5例。24例患者术后锁骨下动脉狭窄均明显改善,椎动脉反向血流消失,术前患、健侧收缩压差为(38±16)mmHg,术后为(10±6)mmHg。除1例穿刺部位血肿外,无其他并发症发生。结论支架置入+球囊扩张是治疗锁骨下动脉盗血的有效手段,术后严格抗凝、抗血小板治疗可取得理想效果。TCD可以连续及动态观察椎动脉、基底动脉血流方向和速度,观察颅内其他动脉被盗血的影响程度,是盗血综合征的敏感指标,且检查费用低廉、无创伤性,可用于评价治疗效果和随访观察。

Objective To observe the short-term effectiveness of the percutaneous transluminal angioplasty and stent placement in the treatment of left subclaviansteal syndrome. Methods 24 patients with left subclaviansteal syndrome between 2005 and 2007 were selected. The constictive degree of the patients were all more than 85% of lumens＇ diameter, and all patients were treated with percutaneous transluminal angioplasty（PTA） and stent placement（SP）, then the effectiveness was evaluated in the third month and the sixth month post-operatively by transcranial Doppler sonography （TCD）. Results 19 patients showed contratlow developing and 5 patients showed dim developing in cerebral angiography before the interventional therapy. After PTA and SP, the stenosis of subclaviansteal artery was obviously improved, and the contraflow of vertebral artery was disappeared. The mean systolic blood pressure difference between left and right upper limb after therapy was obvious lower than that before therapy （10±6mmHg vs 38±16mmHg）. One patient suffered from the hematoma of operative region and the rest had no complications. Conclusions PTA and SP are effective in the treatment of subclaviansteal syndrome. Anticoagulation and antiplatelet therapy after interventional treatment has a good therapeutic effect. TCD may be used for the observation of the direction and velocity of vertebral-basilar artery＇ s blood stream and evaluation of blood stream＇ s dysfunction of other intracal arteries. TCD is not only a cheap and sensitive but also non-invasive method for evaluating steal syndrome.