Kablak-Ziembicka Anna, Przewlocki Tadeusz, Pieniazek Piotr, Musialek Piotr, Kozanecki Artur, Stopa Ireneusz, Zalewski Jaroslaw, Tracz Wieslawa
Department of Cardiac and Vascular Diseases, The John Paul II Hospital, Institute of Cardiology, Collegium Medicum Jagiellonian University, 31-202 Krakow, Poland.
Cardiovasc Intervent Radiol. 2007 Sep-Oct;30(5):894-900. doi: 10.1007/s00270-007-9011-z.
Subclavian or innominate artery (SIA) stenosis affects up to 5% of patients referred to coronary bypass grafting; it is symptomatic in less than half of these. This study aimed to assess the Doppler ultrasonography (DU) findings in SIA obstruction and patients' follow-up after percutaneous angioplasty (PTA).
The study enrolled 118 patients (68 men, 50 women), aged 61.3 +/- 8.7 years, with suspected SIA obstruction, in whom peak systolic velocity (PSV) in the SIA and subclavian steal grade were assessed on DU and verified by quantitative angiography (QA). Serial follow-up DU was performed in patients treated with PTA.
Grade I-III of subclavian steal from the vertebral artery (VA) was found in 89.8% of patients. In the remaining 10.2% only a PSV increase in the SIA was observed. QA confirmed the presence of SIA obstruction in all patients (stenosis grade: 80.9 +/- 17.3%). In patients with one-sided SIA obstruction, the ultrasonographic steal grade correlated with the QA stenosis grade (p < 0.001, r = 0.648). Lack of subclavian steal was noted in the case of distal subclavian stenosis, VA obstruction, VA originating from the aortic arch, and bilateral SIA obstruction. Successful PTA was performed in 77 of 83 patients referred to that procedure. PSV was reduced from 4.4 +/- 1.2 (2.2-6.5) m/sec to 1.34 +/- 0.51 (0.5-2.5) m/sec and flow in the VA was normalized. During the mean follow-up time of 24.7 +/- 15.6 months, there was a gradual increase in the in-stent PSV as well as gradual VA flow alterations, resulting in symptom recurrence. More than a twofold PSV increase, compared with the post-PTA values, was an indicator of restenosis in 11 of 12 patients.
Careful DU evaluation enables the recognition of SIA obstruction in all patients. Ninety percent of them have subclavian steal correlating with the stenosis grade. Restenosis can be reliably detected with DU based on in-stent PSV and VA flow alterations.
锁骨下动脉或无名动脉（SIA）狭窄在接受冠状动脉搭桥术的患者中发生率高达5%；其中不到一半有症状。本研究旨在评估SIA阻塞的多普勒超声（DU）检查结果以及经皮血管成形术（PTA）后患者的随访情况。
本研究纳入了118例年龄为61.3±8.7岁、疑似SIA阻塞的患者（68例男性，50例女性），通过DU评估SIA的收缩期峰值流速（PSV）和锁骨下窃血分级，并经定量血管造影（QA）验证。对接受PTA治疗的患者进行系列随访DU检查。
89.8%的患者存在I - III级椎动脉（VA）锁骨下窃血。其余10.2%的患者仅观察到SIA的PSV升高。QA证实所有患者均存在SIA阻塞（狭窄分级：80.9±17.3%）。在单侧SIA阻塞的患者中，超声窃血分级与QA狭窄分级相关（p < 0.001，r = 0.648）。在锁骨下动脉远端狭窄、VA阻塞、VA起源于主动脉弓以及双侧SIA阻塞的情况下未发现锁骨下窃血。83例接受该手术的患者中有77例PTA成功。PSV从4.4±1.2（2.2 - 6.5）m/秒降至1.34±0.51（0.5 - 2.5）m/秒，VA血流恢复正常。在平均24.7±15.6个月的随访期间，支架内PSV逐渐升高，VA血流也逐渐改变，导致症状复发。与PTA后的值相比，PSV升高超过两倍是12例患者中11例再狭窄的指标。
仔细的DU评估能够识别所有患者的SIA阻塞。其中90%存在与狭窄分级相关的锁骨下窃血。基于支架内PSV和VA血流改变，DU能够可靠地检测再狭窄。
