锁骨下动脉盗血综合征并文献复习

摘要

Objective To explore the clinical manifestations,imaging examination features,diagnosis and treatment strategies of subclavian steal syndrome (SSS).Methods The clinical data,transcranial doppler ultrasonography (TCD) manifestations and treatment process of 2 patients with SSS were retrospectively analyzed and the relevant literature were reviewed.Results Case 1,male,51 years old,hospitalization for "weakness of left upper limb for 4 h".TCD:the initial blood flow velocity of left subclavian artery was increased and early diastolic blood flow was disappeared,which suggested severe stenosis;the blood flow of left vertebral artery was completely reversed,which suggested subclavian steal 3 stage;there was a notch on the right vertebral artery systolic;Trousseau's test (+),the blood flow velocity decreased after loosening the band,which indicated right subclavian steal 1 stage.Percutaneous endovascular angioplasty was given,followed by clopidogrel (75 mg/d).Three months later,TCD showed complete left subclavian artery steal and normal artery blood flow of right vertebral artery.Case 2,male,59 years old,hosptalization for " discontinuous weakness of the right upper limb and vertigo for 4 months".TCD:bidirectional blood flow of left vertebral artery was observed,suggested steal 2 phase;the blood flow velocity and direction of right vertebral artery was normal;the flow velocity of left clavicle artery increased;Trousseau's test (+);the blood flow was reversed throughout the cardiac cycle after loosening the band,thus considering left subclavian steal with steal way of left vertebral artery to left subclavian artery.A stent was placed in the left subclavian arterty,followed by clopidogrel (300 mg of loading dose,75 mg/d of maintenance dose);3 months later,there was no recurrence.Conclusion TCD is the first choice for screening SSS;for those SSS patients with symptoms,angioplasty and stent implantation are preferred.%目的 探讨锁骨下动脉盗血综合征(SSS)患者的临床表现、影像学检查、诊断和治疗策略.方法 回顾性分析2例SSS患者的临床资料、经颅多普勒超声(TCD)表现及治疗过程,并复习相关文献.结果 例1:男,51岁,因“左上肢体无力4h”入院.TCD:左侧锁骨下动脉起始部血流速度增快,舒张早期反向血流消失,提示严重狭窄.左侧椎动脉血流完全反向,提示左侧锁骨下动脉盗血3期.右侧椎动脉收缩期有切迹,束臂试验(+),松开袖带后血流速度下降,提示有侧锁骨下动脉盗血1期.行经皮腔内血管成形术后患者每日口服75 mg氯吡格雷.3个月后颈部超声显示左侧锁骨下动脉完全性盗血,右侧椎动脉血流正常.例2:男,59岁.因“右上肢间断性无力伴眩晕4个月”入院.TCD:左侧椎动脉双向血流即收缩期反向舒张期正常,提示盗血2期.右侧椎动脉及基底动脉血流速度及方向正常.左侧锁骨下动脉流速增快.束臂试验(+),松开袖带后出现整个心动周期全程反向血流,考虑左侧锁骨下动脉盗血,盗血途径:左侧椎动脉到左侧锁骨下动脉.左侧闭塞的锁骨下动脉放置支架后再通,术后给予患者氯吡格雷300 mg负荷剂量后每日75 mg维持剂量,随访半年未出现症状复发.结论 TCD是SSS患者的首选筛查于段.对于有症状的SSS患者,血管成形术和支架置入可能优于开放性手术.