锁骨下动脉狭窄性病变分型与后循环缺血的关联性研究

Correlation between subclavian artery stenosis disease classification and posterior circulation ischemia

目的探讨锁骨下动脉狭窄性病变(SASD)分型与后循环缺血的关联性。方法回顾性分析齐齐哈尔医学院附属第二医院脑血管狭窄诊疗中心和火箭军特色医学中心神经内科自2018年5月至2023年8月收治的81例SASD患者的临床资料、多普勒血管超声及血管影像学检查结果。根据SASD是否合并其他后循环动脉(基底动脉、椎动脉、锁骨下动脉远段)狭窄/闭塞性病变将SASD分为2型(单发型、合并型),根据有无后循环缺血将SASD分为3组(无后循环缺血组、后循环短暂性缺血发作组及后循环脑梗死组),分析不同SASD分型的锁骨下动脉窃血(SS)途径并探讨其与后循环缺血的关联性。结果单发型SASD患者44例(54.3%),主要启动椎动脉→椎动脉→SS途径(26例);并发型SASD患者37例(45.7%),主要启动枕动脉→颈深动脉→肋颈干→SS途径(10例)。无后循环缺血组患者65例(80.2%),后循环短暂性缺血发作组患者4例(4.9%),后循环脑梗死组患者12例(14.8%)。44例单发型SASD患者中39例未出现后循环缺血,3例出现后循环脑梗死;37例并发型SASD患者中26例未出现后循环缺血,9例出现后循环脑梗死。结论SASD患者启动何种窃血途径与SASD分型相关,并发型SASD患者更易出现后循环缺血。

ObjectiveTo explore the correlation between subclavian artery stenosis disease(SASD)classification and posterior circulation ischemia.MethodsA retrospective study was performed;the clinical data,and Doppler vascular ultrasound and vascular imaging results of 81 SASD patients,admitted to Cerebrovascular Stenosis Diagnosis and Treatment Center,Second Affiliated Hospital of Qiqihar Medical College and Department of Neurology,Rocket Force Specialty Medical Center from May 2018 to August 2023,were collected.SASD was categorized into 2 types(single type and concurrent type)based on the presence or absence of other posterior circulation artery(basilar artery,vertebral artery,or subclavian artery distal segment)stenosis/occlusion,and into 3 groups(non-posterior circulation ischemia group,posterior circulation transient ischemic attack group and posterior circulation cerebral infarction group)based on the presence or absence of posterior circulation ischemia.Blood stealing pathways in different SASD classifications were analyzed,and correlation of SASD classification with posterior circulation ischemia was discussed.ResultsSingle-type SASD was noted in 44 patients(54.3%),mainly initiating blood stealing through the vertebral artery to the vertebral artery and then to the subclavian artery(n=26);concurrent-type SASD was noted in 37 patients(45.7%),mainly initiating blood stealing through the occipital artery to the costocervical trunk and then to the subclavian artery(n=10).Sixty-five patients(80.2%)were into the non-posterior circulation ischemia group,4(4.9%)into the posterior circulation transient ischemic attack group and 12(14.8%)into the posterior circulation cerebral infarction group.Among the 44 patients with single-type SASD,39 did not have posterior circulation ischemia,and 3 had posterior circulation cerebral infarction.Among the 37 patients with concurrent-type SASD,26 did not have posterior circulation ischemia,and 9 had posterior circulation cerebral infarction.ConclusionInitiation of blood stealing in SASD patients is related to SASD classification,and concurrent-type SASD patients trend to have posterior circulation ischemia.