锁骨下动脉近段重度以上狭窄者同侧椎动脉无盗血频谱现象分析

Analysis of ipsilateral vertebral artery no steal spectrum phenomenon in patients with proximal subclavian artery severe stenosis

目的探讨锁骨下动脉近段重度以上狭窄者同侧椎动脉无盗血频谱现象的原因。方法回顾性分析16例椎动脉无盗血现象的锁骨下动脉重度以上狭窄者的彩色多普勒超声检查结果,所有病例均在1周内行DSA(或CTA)检查证实。结果锁骨下动脉重度以上狭窄无同侧椎动脉盗血者合并同侧椎动脉起源于主动脉弓者4例,双侧锁骨下动脉重度狭窄合并一侧或双侧颈内动脉重度以上狭窄者6例,一侧锁骨下动脉重度狭窄合并同侧椎动脉闭塞者3例,一侧锁骨下动脉重度狭窄合并对侧椎动脉开口及一侧颈总动脉重度狭窄者2例,头臂动脉闭塞合并对侧椎动脉开口重度狭窄者1例。结论锁骨下动脉重度以上狭窄如合并多支颈部血管狭窄(或闭塞)者,或合并同侧椎动脉起源异常者可无椎动脉盗血现象,此时不能以盗血的有无来判定锁骨下动脉狭窄的程度。

Objective To analyze the cause of the ipsilateral vertebral artery no steal spectrum phenomenon in patients with proximal subclavian artery severe stenosis. Methods Ultrasonic results of 16 patients with subclavian artery severe steuosis without steal spectrum were analyzed retrospectively and confirmed by DSA or CTA examination in a week. Results Four cases of subclavian artery severe stenosis without steal spectrum accompanied by ipsilateral vertebral artery originated in aortic arch, 6 cases of bilateral subclavian artery severe stenosis accompanied by unilateral or bilateral internal carotid artery severe stenosis, 3 cases of unilateral subclavian artery severe stenosis accompanied by ipsilateral vertebral artery occlusion, 2 cases of unilateral subclavian artery severe stenosis accompanied by contralateral vertebral artery opening and unilateral common carotid artery severe stenosis and 1 case of brachiocephalic artery occlusion accompanied by contralateral vertebral artery opening severe stenosis. Conclusion There may be no steal spectrum phenomenon in patients with proximal subclavian artery severe stenosis accompanied by neck vascular stenosis or occlusion,or accompanied by anomalous origin of ipsilateral vertebral artery. By this time, the vertebral artery waveform can＇ t be used to determine the degree of subclavian artery stenosis.