重度锁骨下动脉盗血综合征的侧支代偿及临床特点

Collateral compensation and clinical characteristics of severe subclavian steal syndrome

目的探讨重度锁骨下动脉盗血综合征(SSS)的侧支代偿及临床特点。方法回顾性分析12例经全脑数字减影血管造影(DSA)证实为重度SSS患者的临床资料。结果 12例SSS患者主要临床表现为发作性头晕、视物旋转、跌倒等,活动同侧上肢后症状加重;DSA示左侧锁骨下动脉重度狭窄或闭塞10例,双侧锁骨下动脉重度狭窄2例;侧支代偿途径椎动脉-椎动脉-锁骨下动脉10例,颈内动脉-后交通动脉-大脑后动脉/基底动脉8例,颈外动脉-枕动脉下支-椎动脉肌支动脉-椎动脉-锁骨下动脉9例。8例患者行锁骨下动脉支架成形术后临床症状完全消失;2例患者因锁骨下动脉闭塞及对侧椎动脉中度狭窄而接受对侧椎动脉支架成形术,术后症状减轻;随访3个月～2.5年,症状无复发。结论重度SSS临床表现主要为发作性头晕,侧支代偿途径主要为椎动脉-椎动脉-锁骨下动脉,支架成形术可纠正血流动脉动力学紊乱,缓解临床症状。

Objective To explore the collateral compensation and clinical characteristics of severe subclavian steal syndrome（SSS）.Methods The clinical data of 12 patients with severe SSS conformed by cerebral digital subtraction angiography（DSA） were analyzed retrospectively.Results The main clinical manifestations of the 12 SSS patients were repeated dizzy,feeling rotation,falling down and so on,and which became aggravate after activities with ipsilateral unper limb.DSA showed that the left subclavian artery severe stenosis or occlusion in 10 cases and bilateral subclavian artery severe stenosis in 2 cases.The ways of collateral compensation were vertebral artery-vertebral artery-subclavian artery in 10 cases,internal carotid artery-posterior communicating artery-posterior cerebral artery/basilar artery in 8 cases,external carotid artery-occipital artery inferior branches-ramimusculares arteriae vertebralis-vertebral artery-subclavian artery in 9 cases.The 8 cases recived subclavian artery stent angioplasty and the clinical symptoms were completely disappeared.The 2 cases recived contralateral vertebral artery stent angioplasty because who had with subclavian artery occlusion and contralateral vertebral artery moderate stenosis.After operation the symptoms were relieved,and also no recurrenced after following up 3 months-2.5 years.Conclusions Repeated dizzy is the main clinical symptom of severe SSS.The main way of collateral compensation is vertebral artery-vertebral artery-subclavian artery.The stent angioplasty can correct the hemodynamics disorder and relieve the clinical symptoms.