彩色多普勒超声在锁骨下动脉狭窄介入治疗中的价值

The value of color Doppler ultrasound in interventional therapy of subclavian arterial stenosis

目的评价彩色多普勒超声在锁骨下动脉狭窄诊断及血管内支架植入术后随访中的价值。方法对38例动脉粥样硬化性脑梗死或一过性脑缺血患者行数字减影血管造影(DSA)和彩色多普勒超声检查,检出锁骨下动脉近心段中至重度狭窄或闭塞44支(6例双侧),40支行血管内成形和支架植入术,术后彩色多普勒超声对锁骨下动脉支架情况进行随访。结果锁骨下动脉动脉粥样硬化性阻塞主要局限于近心段。彩色多普勒超声诊断锁骨下动脉近心段阻塞与DSA的符合率达90.9%(40/44)。35支锁骨下近心段阻塞合并盗血。手术成功率95%(38/40)。术后平均随访18个月(3～63个月),发现8支支架植入术后再狭窄,分别为支架内内膜增生狭窄6支,支架弹性回缩及支架断裂塌陷狭窄各1支,血管植入支架后再狭窄率21.1%(8/38)。无严重并发症发生。结论彩色多普勒超声诊断锁骨下动脉近心段狭窄准确可靠,可作为锁骨下动脉近心段阻塞性病变介入术前评价和术后随访中的首选手段。

Objective To evaluate the value of color Doppler ultrasound （CDU） in the diagnosis of subclavian artery （SA） stenosis and follow-ups after endovascular stent placement. Methods From January 2002 to October2007, in 38 patients with cerebral infarction or transient cerebral ischemie attack （TIA） , 44 proximal fragments of SA （6 eases with bilateral lesions） astherosclerotie medium to severe stenosis or occlusion were identified by digital substraction angiography （DSA） and CDU preoperatively. Percutaneous transluminal angioplasty and stent placement （PSTA） were carried out in 40 arteries. All stents implanted were followed by CDU. Results The SA astherosclerotic lesions were mainly located in the promximal fragments. The consistency of the degree of SA stenosis detected by DSA and CDU was 90.9% （40/44）. The procedure was technically successful in 38 of 40 arteries. No major complications occurred. A total of 35 arteries had steal phenomena. During the mean 18-month follow-up （range 3-63 months） , 8 arteries were detected as restenosis after operation, 6 with in-stent restenosis, 1 with stent ruptured and 1 with stent compressed, respectively, and the restenosis rate of stent implanted was 21.1% （8/38）. Conclusions As an accurate and robust method, CDU may be selected as the first choice for evaluating the severity of SA obstruction and patients＇ following-up after endovaseular stent placement.