de Souza Jorge Marcondes, Espinosa Gaudêncio, Santos Machado Magnus, Soares Paulo José
Service of Neurosurgery of the Universidade Federal do Rio de Janeiro, Brazil.
Surg Neurol. 2007 Mar;67(3):298-302; discussion 302. doi: 10.1016/j.surneu.2006.04.013. Epub 2006 Nov 16.
Treatment of subclavian artery occlusion is still a matter of controversy due to the short- and long-term complications and patency issues. We report an unusual case of combined occlusion of the proximal segment of the left subclavian artery and subclavian steal phenomenon associated with bilateral occlusion of the internal carotid arteries.
A 55-year-old male patient with previous history of myocardial infarction and hypertension presented with amblyopia and recurrent dizziness, mainly at work. Doppler fluxometry and digital subtraction angiography depicted proximal left subclavian artery occlusion and subclavian steal. Internal carotid arteries were occluded at the common carotid artery bifurcation. Percutaneous transluminal angioplasty and stenting (PTAS) were successfully performed by the left radial artery approach without complications. The patient had no recurrence of the symptoms, and the angiographic follow-up at 1 year showed good patency of the subclavian artery and normal flow through the left vertebral artery.
The planned approach for the case (PTAS) was performed without complications and evidence of restenosis in the angiography study at the completion of the first year of the treatment. The described strategy is safe and should be considered the first-choice procedure in the treatment of the subclavian occlusion.
由于存在短期和长期并发症以及通畅性问题，锁骨下动脉闭塞的治疗仍存在争议。我们报告一例罕见病例，该病例为左锁骨下动脉近端节段合并闭塞及锁骨下动脉窃血现象，同时伴有双侧颈内动脉闭塞。
一名55岁男性患者，有心肌梗死和高血压病史，主要在工作时出现视力模糊和反复头晕症状。多普勒血流测定和数字减影血管造影显示左锁骨下动脉近端闭塞及锁骨下动脉窃血。颈内动脉在颈总动脉分叉处闭塞。通过左桡动脉途径成功进行了经皮腔内血管成形术和支架置入术（PTAS），无并发症发生。患者症状未复发，治疗1年后的血管造影随访显示锁骨下动脉通畅良好，左椎动脉血流正常。
该病例所采用的治疗方案（PTAS）在治疗第一年结束时的血管造影研究中未出现并发症，也无再狭窄迹象。所描述的治疗策略是安全的，应被视为锁骨下动脉闭塞治疗的首选方法。
