1
|
Zhang L, Wang L, Yan Y, Tao Q, Gu X. Relationship between subclavian artery stenosis lesions and posterior circulation infarction: A preliminary study. Ann Vasc Surg 2024:S0890-5096(24)00237-1. [PMID: 38821478 DOI: 10.1016/j.avsg.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/03/2024] [Accepted: 03/23/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE To investigate the correlation between subclavian steal syndrome and posterior circulation infarction using magnetic resonance imaging. METHODS A total of 294 patients diagnosed with subclavian steal syndrome using carotid Doppler ultrasonography were retrospectively included. According to the magnetic resonance imaging results, they were divided into posterior circulation infarction group and non- posterior circulation infarction group. Clinical indicators and carotid Doppler ultrasound parameters of patients were collected, and they were screened to establish a multiple logistic regression model. Receiver operating characteristic curve analysis of the established multiple logistic regression model was performed, and the area under the curve was calculated to evaluate the predictive efficiency of the model. RESULTS After statistical analysis of all parameters of the two groups of patients, a total of 10 parameters were included in multiple logistic regression to establish a model. The results showed a correlation between posterior circulation infarction and subclavian artery occlusion, grade III subclavian steal syndrome, gender, vulnerable plaques, National Institutes of Health Stroke Scale score, and age. After the receiver operating characteristic curve analysis of the model, the area under the curve for the multiple logistic regression model was 0.773. CONCLUSION The multiparameter composite model based on clinical baseline data and carotid Doppler ultrasonography parameters can effectively predict posterior circulation infarction and offer novel insight for clinical diagnosis.
Collapse
Affiliation(s)
- Lingyan Zhang
- Department of Ultrasound, The Fourth Affiliated of Soochow University, Suzhou, China
| | - Lei Wang
- Department of Ultrasound, The Fourth Affiliated of Soochow University, Suzhou, China
| | - Yanhong Yan
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qing Tao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinxian Gu
- Department of Ultrasound, The Fourth Affiliated of Soochow University, Suzhou, China.
| |
Collapse
|
2
|
Neupane D, Kafle S, Chhetri V, Koirala A. Subclavian steal syndrome. Clin Case Rep 2024; 12:e8561. [PMID: 38469130 PMCID: PMC10925801 DOI: 10.1002/ccr3.8561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/12/2024] [Accepted: 01/31/2024] [Indexed: 03/13/2024] Open
Abstract
Early recognition and diagnosis of subclavian steal syndrome are vital to avoid unnecessary investigations and ensure appropriate management. This case highlights the significance of comprehensive evaluation, including bilateral blood pressure measurement, in patients with unilateral symptoms.
Collapse
Affiliation(s)
- Durga Neupane
- B.P. Koirala Institute of Health SciencesDharanNepal
| | - Sujan Kafle
- B.P. Koirala Institute of Health SciencesDharanNepal
| | | | | |
Collapse
|
3
|
Zalaquett Z, Zgheib G, Karam L, Zaatar M, Nehme K, Tabet G. A rare association of subclavian steal syndrome with bilateral carotid artery stenosis: a case report. J Vasc Surg Cases Innov Tech 2023; 9:101243. [PMID: 37799832 PMCID: PMC10547741 DOI: 10.1016/j.jvscit.2023.101243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/26/2023] [Indexed: 10/07/2023] Open
Abstract
Bilateral carotid artery stenosis in the context of subclavian steal syndrome is an extremely rare finding. We report the case of a 75-year-old woman who presented with a transient ischemic attack. Bilateral internal carotid stenosis associated with left subclavian steal syndrome was diagnosed. Left internal carotid endarterectomy was performed under locoregional anesthesia. Inflation of a blood pressure cuff reversed the neurologic symptoms that appeared after internal carotid clamping. This rarely reported case remains a challenge to diagnose and treat because of its complex mechanisms and multiple risk factors. Our case highlights the importance of the surgical strategy adopted and the need for a good initial assessment.
Collapse
Affiliation(s)
- Ziad Zalaquett
- Department of Thoracic and Cardiovascular Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Ghady Zgheib
- Department of Thoracic and Cardiovascular Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Lamisse Karam
- Department of Thoracic and Cardiovascular Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Maya Zaatar
- Department of Radiology and Medical Imaging, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Karim Nehme
- Department of Thoracic and Cardiovascular Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Georges Tabet
- Department of Thoracic and Cardiovascular Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| |
Collapse
|
4
|
McCluskey M, Baber P, Rind S, Xu D. Variant of subclavian steal syndrome: unusual anatomical relationship between left subclavian artery and left vertebral artery. BMJ Case Rep 2023; 16:e252966. [PMID: 37185244 PMCID: PMC10151969 DOI: 10.1136/bcr-2022-252966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
A woman in her 70s presented to her general practitioner (GP) with a 3-month history of left upper arm pain and weakness. A significant difference in bilateral blood pressures was noted and a further history elicited coolness in her left arm without functional compromise. A CT angiography revealed variant subclavian steal syndrome with a subclavian arterial stenosis, which was proximal to both the internal mammary and thyrocervical trunk and her left vertebral artery originating from the aortic arch. She was referred to a vascular surgeon but declined surgical intervention. Her symptoms remain stable with 6-month follow-up from her GP. This case highlights the importance of considering vascular aetiologies in upper limb pain and weakness. Our case reviews the differential diagnoses of upper limb pain and weakness, consequently leading to the discussion of an interesting variant of subclavian stenosis.
Collapse
Affiliation(s)
- Mia McCluskey
- Curtin Medical School, Curtin University Bentley Campus, Perth, Western Australia, Australia
| | - Peter Baber
- Radiology Department, SKG Radiology, Murdoch, Western Australia, Australia
| | - Shahmir Rind
- Curtin Medical School, Curtin University Bentley Campus, Perth, Western Australia, Australia
| | - Dan Xu
- Curtin Medical School, Curtin University Bentley Campus, Perth, Western Australia, Australia
- Medical Education & General Practice, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| |
Collapse
|
5
|
Shankar DS, Rybalko DA, Goldman D, Nowakowski FS, Hausman MR. Applications of Vascular Imaging and Interventional Radiology Modalities in the Upper Extremity: A Review. J Hand Surg Am 2023; 48:165-176. [PMID: 36333243 DOI: 10.1016/j.jhsa.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 04/30/2022] [Accepted: 09/14/2022] [Indexed: 01/01/2023]
Abstract
Hand and upper extremity (HUE) vascular disorders are encountered frequently by hand surgeons in clinical practice. A wide array of imaging and vascular interventional radiology modalities exists for the diagnosis and treatment of HUE vascular disorders, some of which may not be familiar to the HUE surgeons. In this review article, we summarize the vascular imaging and vascular interventional radiology modalities and their relative advantages, disadvantages, and indications with respect to HUE pathology. We aim to familiarize HUE surgeons with the available types of diagnostic and therapeutic options for HUE vascular pathologies and aid interdisciplinary communication with vascular interventional radiology specialists during the clinical decision-making process.
Collapse
Affiliation(s)
- Dhruv S Shankar
- Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | - Daryl Goldman
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | |
Collapse
|
6
|
Chen Y, Li W, Li K. Computed Tomography Angiography in the Diagnosis of Subclavian-Vertebral Artery Steal. Int J Gen Med 2022; 15:7951-7959. [PMID: 36317100 PMCID: PMC9617550 DOI: 10.2147/ijgm.s384470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Computed tomography angiography (CTA) is commonly used in the diagnosis and evaluation of subclavian steal (SS). However, the abnormal manifestations of vertebral artery (VA) in SS on CTA are vastly under-recognized and prone to misdiagnosis. We reported for the first time the abnormal CTA manifestations of VA in SS, and evaluated the value and pitfalls of CTA in the diagnosis of SS, aiming to avoid misdiagnosis and facilitate correct diagnosis of SS using CTA. Patients and Methods This study retrospectively included 19 patients diagnosed with SS using carotid duplex sonography (CDS) and digital subtraction angiography (DSA) between 2018 and 2022 at a tertiary neurology clinic in Chongqing, China. Their CDS, DSA and CTA results were collected and analyzed. The diagnostic consistency between CTA and DSA in grading subclavian artery stenosis was evaluated, and the CTA manifestations of VA were summarized. Results All patients presented subclavian steno-occlusion on the affected side, without steno-occlusion of the contralateral subclavian artery or bilateral VA on DSA. A high concordance was observed between CTA and DSA in grading subclavian artery stenosis (Kappa = 0.825, P = 0.000). However, only 26.3% of patients presented normal VA on CTA, whereas 73.7% of patients presented shallow VA ipsilateral to subclavian steno-occlusion. A 28.6% of patients with shallow VA were misdiagnosed as having vertebral arteriopathy. The presence of shallow VA had no significant correlation with age, gender, severity of subclavian artery stenosis, diameter of VA or model of CT scanner (all P>0.05). Although not statistically significant, the incidence of shallow VA increased with higher SS grade. Conclusion Carotid CTA is highly accurate for diagnosing subclavian steno-occlusion, whereas shallow VA is the pitfall of CTA in diagnosing SS. It is important to improve the recognition of shallow VA to avoid misdiagnosis.
Collapse
Affiliation(s)
- Yanru Chen
- Neurology Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China,Correspondence: Yanru Chen, Neurology Department, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400010, People’s Republic of China, Tel +86 13983100640, Email
| | - Wenqi Li
- Neurology Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Kunhua Li
- Radiology Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| |
Collapse
|
7
|
Shaban S, Huasen B, Haridas A, Killingsworth M, Worthington J, Jabbour P, Bhaskar SMM. Digital subtraction angiography in cerebrovascular disease: current practice and perspectives on diagnosis, acute treatment and prognosis. Acta Neurol Belg 2022; 122:763-780. [PMID: 34553337 DOI: 10.1007/s13760-021-01805-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
Digital Subtraction Angiography (DSA) is the gold-standard imaging modality in acute cerebrovascular diagnosis. The role of DSA has become increasingly prominent since the incorporation of endovascular therapy in standards of care for acute ischemic stroke. It is used in the assessment of cerebral vessel patency; however, the therapeutic role of DSA from a prognostic standpoint merits further investigation. The current paper provides an update on current practice on diagnostic, therapeutic and prognostic use of DSA in acute cerebrovascular diseases and various indications and perspectives that may apply, or limit its use, in ongoing surveillance or prognosis. Pre-clinical and clinical studies on the aspects, including but not limited to the morphology of cerebrovasculature in acute ischaemic stroke, are required to delineate and inform its prognostic role.
Collapse
Affiliation(s)
- Shirin Shaban
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, NSW, Australia
| | - Bella Huasen
- Department of Interventional Radiology, Lancashire University Teaching Hospitals, Lancashire Care NHS Foundation Trust, Preston, UK
| | - Abilash Haridas
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- Baycare Medical Group, Pediatric Neurosurgery, Cerebrovascular and Skull Base Neurosurgery, St Joseph's Hospital, Tampa, FL, USA
| | - Murray Killingsworth
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, Australia
- Department of Anatomical Pathology, Correlative Microscopy Facility, NSW Health Pathology, Sydney, Australia
| | - John Worthington
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- RPA Comprehensive Stroke Service and Department of Neurology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Pascal Jabbour
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Sonu Menachem Maimonides Bhaskar
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia.
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, NSW, Australia.
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, Australia.
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, Australia.
- Department of Neurology and Neurophysiology, Clinical Sciences Building, Liverpool Hospital, Elizabeth St, Liverpool, NSW, 2170, Australia.
| |
Collapse
|
8
|
Qiu T, Fu SQ, Deng XY, Chen M, Dai XY. Subclavian artery stenting via bilateral radial artery access: Four case reports. World J Clin Cases 2022; 10:1747-1753. [PMID: 35211618 PMCID: PMC8855260 DOI: 10.12998/wjcc.v10.i5.1747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/04/2021] [Accepted: 01/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Subclavian artery stenosis refers to the stenosis in the lumen caused by the presence of plaque or thrombus in the subclavian artery. It is a common problem in endovascular interventions. In fact, conventional subclavian artery stenting via the femoral artery approach is effective and safe. Nevertheless, because femoral artery puncture is not easy to stop bleeding, it requires longer femoral artery compression or more expensive hemostatic materials, such as staplers. Patients need to be catheterized and bedridden for a longer time, which may lead to many complications, such as pseudoaneurysm.
CASE SUMMARY Herein, we reported a new interventional therapy of subclavian artery. From March 1, 2020 to August 31, 2021, we operated on four patients with subclavian artery stenting via bilateral radial artery access.
CONCLUSION After reviewing four cases of successful placement of clavicular artery stents via bilateral radial arteries, we concluded that bilateral radial artery approach is feasible. Clavicular artery stenting is safe, effective, and timesaving. It is an excellent alternative to the traditional femoral artery procedure, with few complications and high comfort degree.
Collapse
Affiliation(s)
- Tao Qiu
- Department of Neurology, Zigong First People's Hospital, Zigong 643000, Sichuan Province, China
| | - Sheng-Qi Fu
- Department of Neurology, Zigong First People's Hospital, Zigong 643000, Sichuan Province, China
| | - Xiao-Yong Deng
- Department of Neurology, Zigong First People's Hospital, Zigong 643000, Sichuan Province, China
| | - Ming Chen
- Department of Neurology, Zigong First People's Hospital, Zigong 643000, Sichuan Province, China
| | - Xiao-Yan Dai
- Department of Equipment Management, Zigong First People's Hospital, Zigong 643000, Sichuan Province, China
| |
Collapse
|
9
|
Unmasking the Coronary-Subclavian Steal Syndrome: The Culprit Lies in the Subclavian Artery. A Report of a Case and Review of the Literature. Ann Vasc Surg 2021; 74:524.e9-524.e15. [PMID: 33836226 DOI: 10.1016/j.avsg.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 11/20/2022]
Abstract
The coronary-subclavian steal syndrome is a hemodynamic phenomenon in which a subclavian artery stenosis or occlusion impairs blood flow at the origin of the left internal mammary artery used for coronary artery bypass grafting (CABG), causing retrograde blood flow and thus provoking symptoms of cardiac ischemia and its complications. Once considered the gold-standard operation of choice, open revascularization has now been abandoned as a first line treatment and replaced by endovascular techniques. In all cases, detailed and oriented physical examination in combination with further imaging in high clinical suspicion for coronary-subclavian steal syndrome remains the sine qua non of the preoperative examination of the patient. We report the case of a 50-year-old male patient suffering from acute onset angina post- coronary artery bypass grafting and managed by endovascular means.
Collapse
|
10
|
Chen DW, Gao YH, Shi J, Yin YW, Zhang WQ. Significance of hemodynamic assessment by pressure wire for endovascular therapy of subclavian steal syndrome. Interv Neuroradiol 2020; 26:321-328. [PMID: 31969074 DOI: 10.1177/1591019919897765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Subclavian steal syndrome results from hemodynamic impairment due to stenosis or occlusion of subclavian artery. Therefore, it is important for subclavian steal syndrome patients to assess hemodynamic status during endovascular therapy. METHODS Eleven subclavian steal syndrome patients undergoing endovascular therapy attended this study. Pressure wire was used to measure trans-stenosis pressure difference (ΔP). Digital subtraction angiography, Transcranial Doppler and Electronic sphygmomanometer were introduced to assess stenotic rate, steal grade and inter-arm systolic pressure difference, respectively. Clinical symptoms and restenosis were followed up after endovascular therapy. The associations of ΔP with stenotic rate, inter-arm pressure difference, steal degree, clinic symptoms and restenosis were analyzed in this paper. RESULTS Prior to the therapy, ΔP moderately correlated with stenotic rate (r = 0.757, p = 0.007) and inter-arm pressure difference (r = 0.701, p = 0.016). ΔP was ≥6 mmHg in all patients, and 6-9 mmHg for grade 1 steal and ≥10 mmHg for grade 2 and 3 steals. After the therapy, all patients had technique success, and 10 patients had clinic success, and 1 patient appeared restenosis. ΔP was ≤3 mmHg and steal disappeared in the patients with clinical success. ΔP was 18 mmHg and grade 3 steal still existed in one patient without clinical success. One patient with 1 mmHg of ΔP after therapy appeared restenosis in the follow-up. CONCLUSION The trans-stenosis pressure difference is closely related to steal degree and clinical symptoms. The measurement of hemodynamic status by pressure wire is very useful to guide endovascular therapy in subclavian steal syndrome patients. However, the restenosis may still occur, even though the hemodynamic impairment is improved.
Collapse
Affiliation(s)
- Da-Wei Chen
- Department of Neurology, Air Force Medical Center, PLA (People's Liberation Army), Beijing, China
| | - Yu-Hai Gao
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Jin Shi
- Department of Neurology, Air Force Medical Center, PLA (People's Liberation Army), Beijing, China
| | - Yan-Wei Yin
- Department of Neurology, Air Force Medical Center, PLA (People's Liberation Army), Beijing, China
| | - Wei-Qing Zhang
- Department of Neurology, Air Force Medical Center, PLA (People's Liberation Army), Beijing, China
| |
Collapse
|
11
|
Subarachnoid Hemorrhage as Result of Retrocorporeal Artery Aneurysm Rupture: Rare Sequel of Subclavian Steal Syndrome. World Neurosurg 2019; 133:66-68. [PMID: 31574332 DOI: 10.1016/j.wneu.2019.09.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/25/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Subclavian steal phenomenon can cause retrograde flow in the vertebral artery as a result of ipsilateral occlusion of the subclavian artery. This phenomenon has various clinical presentations, such as claudication of the affected extremity or intermittent vertebrobasilar ischemia. Aneurysm formation in the spinal cord circulation is exceptionally rare but may occur secondary to collateral formation in subclavian steal syndrome. CASE DESCRIPTION The case presented herein is a 53-year-old male who presented with headache and severe neck pain. Imaging studies revealed that the patient had subarachnoid hemorrhage in the perimedullary and cervicomedullary cisterns and extending to C3-C7 ventrally. Computed tomography angiography reconstruction demonstrated an aneurysmally dilated vessel dorsal to the C6 vertebral body within the spinal canal. Catheter-based angiography of the right subclavian artery demonstrated retrograde flow within the left vertebral artery and confirmed proximal left subclavian artery occlusion, findings diagnostic of subclavian steal. Further, a branch of the right thyrocervical trunk supplied a retrocorporeal artery collateral to the left vertebral artery, which also contributed to the anterior spinal artery. CONCLUSIONS After endovascular coiling of the aneurysm, the patient had no neurologic deficits or postoperative complications. Postoperative angiography revealed complete obliteration with no residual aneurysm. Imaging further demonstrated patency of the radiculomedullary (anterior spinal) artery.
Collapse
|
12
|
梁 毅, 丘 丽, 谢 静. [Subclavian artery stenosis combined with vertebral artery stenosis may lead to compensatory blood flow changes in the contralateral vertebral artery]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:1509-1513. [PMID: 30613022 PMCID: PMC6744209 DOI: 10.12122/j.issn.1673-4254.2018.12.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the severity of blood steal and the hemodynamic profiles in patients with subclavian artery stenosis combined with vertebral artery stenosis. METHODS A retrospective analysis was performed of transcranial Doppler (TCD) data from patients with subclavian artery stenosis (SAS) and concomitant unilateral/bilateral vertebral artery stenosis (VAS, >50%) or occlusion in our institution between February, 2014 and July, 2018.Thirty-seven patients with SAS combined with VAS (SAS+VAS) were reviewed for types of blood steal, peak systolic velocities of blood flow in affected subclavian artery and the contralateral vertebral artery, and the findings of hyperemia testing.These data were also reviewed for 39 SAS patients without VAS (control group) for comparison of blood steal and hemodynamic profiles. RESULTS In SAS+VAS group, 5 patients showed no blood steal; blood steal in stage Ⅰ was found in 22 patients, stage Ⅱ in 7, and stage Ⅲ in 3, as compared to the numbers of 17, 12 and 10 in the control group, respectively (H=9.431, P=0.002).The peak systolic velocity of the contralateral vertebral artery was 43.91±17.43 cm/s in SAS+VAS group, significantly lower than that in the control group (53.56±17.45 cm/s; t= 629.5, P=0.006).Hyperemia testing showed a significant difference in the negative rate between SAS+VAS group and the control group[35.1%(13/37) vs 7.7%(3/39);χ2=8.603, P=0.003). CONCLUSIONS SAS combined with VAS may lead to reduced compensatory blood flow in the contralateral vertebral artery to lessen the severity of subclavian steal syndrome.
Collapse
Affiliation(s)
- 毅仪 梁
- />广东省人民医院(广东省医学科学院)神经科//广东省神经科学研究所,广东 广州 510080Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, Guangzhou 510080, China
| | - 丽雅 丘
- />广东省人民医院(广东省医学科学院)神经科//广东省神经科学研究所,广东 广州 510080Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, Guangzhou 510080, China
| | - 静芳 谢
- />广东省人民医院(广东省医学科学院)神经科//广东省神经科学研究所,广东 广州 510080Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, Guangzhou 510080, China
| |
Collapse
|