锁骨下动脉盗血综合征经颅多普勒超声检查临床价值

Clinical value of transcranial doppler ultrasound for patients with subclavian steal syndrome

目的研究锁骨下动脉盗血综合征(SSS)的经颅多普勒超声(TCD)表现,并结合数字减影血管造影(DSA)检查探讨TCD对于SSS的诊断和治疗的临床意义和应用价值。方法分析69例经TCD诊断为SSS患者的血流动力学变化,根据患侧椎动脉(VA)频谱特点将盗血分为Ⅰ、Ⅱ、Ⅲ期盗血。初步判断盗血途径,分为健侧VA和/或基底动脉(BA)参与盗血。其中部分患者(39例)行DSA检查,根据DSA检查结果将锁骨下动脉(SubA)狭窄程度分为轻度狭窄(狭窄程度≤50%)、中度狭窄(狭窄程度51～75%)、重度狭窄(狭窄程度76～95%)和闭塞四组。并将各组检查结果与TCD检查结果进行对照分析研究。结果在TCD检查示Ⅰ期盗血的6例患者中,DSA示SubA轻度狭窄患者3例,中度狭窄3例;TCD检查示Ⅱ期盗血的16例患者中,DSA示SubA中度狭窄患者8例,重度狭窄7例,闭塞1例;TCD检查示Ⅲ期盗血的17例患者中,DSA示SubA中度狭窄2例,重度狭窄8例,闭塞7例。TCD检查所发现的盗血程度与DSA检查发现的SubA狭窄程度呈正相关(r=0.78)。结论 TCD是诊断SSS敏感而可靠的方法,为临床早期诊断和治疗提供了可靠的依据。

Objective To study the characteristics of transcranial Doppler ultrasound（TCD） in patients with subclavian steal syndrome （SSS）,and to explore the clinical meaning and value of TCD for diagnosis and treatment in SSS by comparison with digital subtraction angiography（DSA）.Methods To review and analyze the hemodynamic changes of 69 cases which were diagnosed SSS by TCD .According to the spectrum characteristics of ipsilateral Vertebral artery（VA）,the subclavian steal phenomenon is divided into three stages.The steal pathway is defined as VA and/or basilar artery（BA） steal pathway. 39 patirnts were checked by DSA.According to the stenosis degree of subclavian artery（SubA） performed with DSA these patients were divided into four groups： mild stenosis group（stenosis degree≤50%）, medium stenosis group（stenosis degree of 51-75%）,severe stenosis group（stenosis degree of 76-95%）and occlusion group.The results of DSA were compared with TCD.Results Among the 6 cases that are of steal stageⅠaccording to TCD, there are 3 cases with mild stenosis vessels,3 cases with medium stenosis vessels according to the results of DSA. Among the 16 cases that are of steal stageⅡaccording to TCD, there are 8 cases with medium stenosis vessels ,7 cases with severe stenosis vessels,1 cases with occlusion vessels according to the results of DSA. Among the 17 cases that are of steal stageⅢ according to TCD, there are 2 cases with medium stenosis vessels ,8 cases with severe stenosis vessels,7 cases with occlusion vessels according to the results of DSA.There was a positive correlation between the steal degree performed with TCD and the stenosis degree of SubA performed with DSA（r=0.78）.Conclusion TCD is a sensitive and reliable method for diagnosis in SSS and can provide reliable evidence for early clinical diagnosis and treatment .