Thomassen L, Kråkenes J
Tidsskr Nor Laegeforen. 1989 Apr 10;109(10):1063-8.
We report our initial experiences concerning percutaneous transluminal angioplasty of four subclavian artery stenoses and one innominate artery stenosis in four patients. In two patients the indication for percutaneous transluminal angioplasty was a severe subclavian steal syndrome, in one patient prophylactic treatment together with carotid endarterectomy before coronary bypass surgery, and in one patient a brainstem infarction. Percutaneous transluminal angioplasty resulted in normal vertebral artery blood flow in all patients and in complete relief of symptoms in the two patients with a subclavian steal syndrome. We experienced no cerebrovascular complications and only one minor peripheral complication. During a follow-up period of seven to 18 months there has been no re-occlusion and no sign of increasing subclavian steal phenomenon. We draw the following conclusions: Selection criteria for percutaneous transluminal angioplasty must be very strict. Doppler sonography before percutaneous transluminal angioplasty is necessary to evaluate the haemodynamic effect of subclavian stenosis upon the vertebral arteries. Doppler sonographic monitoring during percutaneous transluminal angioplasty should be a routine. The risk of cerebral complications is low. Gradual normalisation of vertebral blood flow after percutaneous transluminal angioplasty is common. Percutaneous transluminal angioplasty is judged to be a safe and effective treatment for patients suffering from subclavian steal syndrome.
我们报告了对4例患者的4处锁骨下动脉狭窄和1处无名动脉狭窄进行经皮腔内血管成形术的初步经验。2例患者经皮腔内血管成形术的指征是严重的锁骨下动脉盗血综合征，1例患者是在冠状动脉搭桥手术前行预防性治疗并同期行颈动脉内膜切除术，另1例患者是脑干梗死。经皮腔内血管成形术使所有患者的椎动脉血流恢复正常，2例锁骨下动脉盗血综合征患者的症状完全缓解。我们未发生脑血管并发症，仅出现1例轻微的外周并发症。在7至18个月的随访期内，未出现再闭塞，也没有锁骨下动脉盗血现象加重的迹象。我们得出以下结论：经皮腔内血管成形术的选择标准必须非常严格。经皮腔内血管成形术前进行多普勒超声检查对于评估锁骨下动脉狭窄对椎动脉的血流动力学影响是必要的。经皮腔内血管成形术期间进行多普勒超声监测应成为常规操作。脑部并发症的风险较低。经皮腔内血管成形术后椎动脉血流逐渐恢复正常是常见的。经皮腔内血管成形术被认为是治疗锁骨下动脉盗血综合征患者的一种安全有效的方法。
