Kilic I D, Alihanoglu Y I, Yildiz B S, Taskoylu O, Evrengul H
Medical Faculty, Department of Cardiology, Pamukkale University, Denizli, Turkey,
Herz. 2015 Apr;40(2):250-4. doi: 10.1007/s00059-013-3925-9. Epub 2013 Aug 8.
Internal mammary artery (IMA) grafts have been shown to be superior to saphenous vein grafts in terms of rare atherosclerotic involvement, biochemical and physical qualities, and long-term patency rates. The IMA originates from the subclavian artery, just distal to the vertebral artery, and an occlusion or a hemodynamically significant stenosis proximal to the IMA ostium would cause a pressure drop distally and a reversal of flow from the coronary arteries to the IMA in patients with this graft. This condition is referred to as "coronary subclavian steal syndrome" (CSSS). In most cases, the cause of this syndrome is atherosclerotic disease; however, other causes of subclavian artery stenosis (SAS) have the potential to lead to CSSS. Patients with CSSS present with the symptoms of myocardial ischemia due to coronary steal, vertebrobasilar insufficiency, or limb ischemia. Discrepancy in the blood pressure (BP) measurements in two arms should warn the clinician of SAS. A diminished pulse or the bruit of jet flow on the lesion side can be noticed. Doppler ultrasonography, computed tomography angiography, and magnetic resonance angiography are safe and accurate noninvasive modes of diagnosis. Treatment can be surgical or percutaneous.
乳内动脉（IMA）移植血管在罕见的动脉粥样硬化累及情况、生化和物理特性以及长期通畅率方面已被证明优于大隐静脉移植血管。乳内动脉起源于锁骨下动脉，恰好在椎动脉远端，而乳内动脉开口近端的闭塞或血流动力学上显著的狭窄会导致远端压力下降，并使接受该移植血管的患者出现冠状动脉血流向乳内动脉逆流的情况。这种情况被称为“冠状动脉锁骨下窃血综合征”（CSSS）。在大多数情况下，该综合征的病因是动脉粥样硬化疾病；然而，锁骨下动脉狭窄（SAS）的其他病因也有可能导致CSSS。CSSS患者会因冠状动脉窃血、椎基底动脉供血不足或肢体缺血而出现心肌缺血症状。双臂血压（BP）测量值的差异应提醒临床医生注意SAS。病变侧可察觉到脉搏减弱或喷射血流的杂音。多普勒超声、计算机断层血管造影和磁共振血管造影是安全且准确的无创诊断方式。治疗可采用手术或经皮介入方法。
