锁骨下动脉闭塞症临床类型与血流代偿途径关系研究

The clinical pattern of subclavian artery occlusion and its correlation with blood stream compensation pathway

目的通过对锁骨下动脉闭塞症影像及临床数据结果分析比较,分析总结闭塞程度、临床症状、椎动脉窃血程度及基底动脉反向血流之间的联系规律。方法对212例锁骨下动脉近端狭窄或完全闭塞患者的资料进行统计,分别分析病变程度与窃血程度、窃血类型、基底动脉缺血症状(VBI)、合并不同侧椎动脉病变与基底动脉缺血发生率等结果的相互关系。结果锁骨下动脉狭窄程度与同侧椎动脉盗血程度成正相关(χ^2=23.5,P<0.05;χ^2=89.7,P<0.05;χ^2=79.5,P<0.05);椎动脉窃血程度与VBI无关(χ^2=1.52,P>0.05);VBI与基底动脉参与窃血相关(χ^2=65.21,P<0.01);合并对侧椎动脉病变时容易引发VBI(86.2%:64.5%,χ^2=5.28,P<0.05),合并同侧病变会降低VBI发生率(40.0%:64.5%,χ^2=5.41,P<0.05)。结论锁骨下动脉狭窄程度与盗血程度成正相关,窃血程度与VBI症状无关,而VBI症状与基底动脉是否参与窃血有关,合并对侧椎动脉病变时容易引发VBI,合并同侧病变会降少VBI发生。掌握认识此规律可能减少漏诊,更准确指导治疗。

Objective To investigate the imaging and clinical data of subclavian artery occlusion,to explore the correlation among the degree of the lesions,clinical symptoms,degree of vertebral artery steal blood and basilar artery ischemia.Methods The clinical data about 212 patients with proximal subclavian artery stenosis or complete occlusion were statistically analyzed,and the correlation amng the degree of the lesions,degree of vertebral artery steal blood and the incidence rate of basilar artery ischemia was analyzed.Results The stenosis degree of subclavian artery lesion was positively correlated with the degree of vertebral artery blood theft(P<0.05),however,the degree of blood steal of vertebral artery was not correlated with VBI(P>0.05).And VBI was associated with basilar artery reflux(P<0.01).The subclavian artery lesion combined with contralateral vertebral artery lesions could resulted in VBI more easily(P<0.05).However the subclavian artery lesion combined with ipsilateral vertebral artery lesions could decrease the incidence rate of VBI(P<0.05).Conclusion The stenosis degree of subclavian artery lesion is positively correlated with the degree of vertebral artery blood theft,and the degree of blood steal of vertebral artery is not correlated with VBI symptome.The subclavian artery lesion combined with contralateral vertebral artery lesions can resulted in VBI more easily,however,the subclavian artery lesion combined with ipsilateral vertebral artery lesions can decrease the incidence rate of VBI.Understanding the rule may reduce missed diagnosis and guide treatment more accurately.