Huibers A, Hendrikse J, Brown M M, Pegge S A, Arnold M, Moll F L, Kapelle L J, de Borst G J
Department of Vascular Surgery, University Medical Centre Utrecht, The Netherlands.
Departments of Radiology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, The Netherlands.
Eur J Vasc Endovasc Surg. 2017 Feb;53(2):153-157. doi: 10.1016/j.ejvs.2016.11.023. Epub 2017 Jan 3.
Blood pressure (BP) regulation is important in patients with carotid artery atherosclerotic disease. Concomitant subclavian artery stenosis (SAS) might lead to an underestimation of the true systemic BP in the monitoring of these patients. This study aimed to assess the prevalence of the inter-arm BP difference in patients undergoing carotid intervention and its association with ipsilateral significant subclavian stenosis and clinical outcome.
Bilateral BP measurements and vascular imaging (CTA and MRA) of both subclavian arteries and the innominate artery were assessed in 182 symptomatic patients with carotid artery stenosis undergoing revascularisation in the International Carotid Stenting Study (ICSS). Data were separately analysed according to previously described cutoff values for systolic BP (SBP) differences of ≥10 and <15 mmHg, ≥15 and <20 mmHg, or ≥20 mmHg. Significant SAS was defined as a >50% diameter reduction.
Of the 182 patients, 39 (21%) showed an inter-arm difference in SBP >15 mmHg. The mean inter-arm SBP difference associated with ipsilateral SAS was 14 mmHg. SAS was present in 21/182 (12%) patients. Only two patients (1%) had bilateral stenotic disease. An inter-arm SBP difference of ≥20 mmHg was associated with unilateral SAS (RR 11.8; 95% CI 3.2-43.1) with a sensitivity of 23% and a specificity of 98%. Patients were followed up for a median of 4.0 years (IQR 3.0-6.0; maximum 7.5). Risk of stroke or death during follow-up was 20.0% (95% CI 11.1-28.9) in patients with, and 15.1% (95% CI 12.3-17.9) in patients without SAS (p = .561). The hospital stay was longer in patients with significant SAS (5.0 days, SD 4.9 vs. 2.7 days, SD 4.3, p = .035).
The present study is the first to affirm the clinical need for the measurement of inter-arm BP differences in patients undergoing carotid revascularisation, especially in the post-operative phase in the prevention of cerebral hyperperfusion.
血压（BP）调节在颈动脉粥样硬化疾病患者中很重要。合并锁骨下动脉狭窄（SAS）可能导致在监测这些患者时低估真实的全身血压。本研究旨在评估接受颈动脉介入治疗患者双臂血压差异的患病率及其与同侧严重锁骨下动脉狭窄和临床结局的关联。
在国际颈动脉支架置入研究（ICSS）中，对182例有症状的颈动脉狭窄患者进行了双侧血压测量以及双侧锁骨下动脉和无名动脉的血管成像（CTA和MRA），这些患者正在接受血运重建治疗。根据先前描述的收缩压（SBP）差异临界值≥10且<15 mmHg、≥15且<20 mmHg或≥20 mmHg对数据进行单独分析。严重SAS定义为直径缩小>50%。
182例患者中，39例（21%）双臂SBP差异>15 mmHg。与同侧SAS相关的双臂SBP平均差异为14 mmHg。182例患者中有21例（12%）存在SAS。只有2例患者（1%）患有双侧狭窄疾病。双臂SBP差异≥20 mmHg与单侧SAS相关（RR 11.8；95% CI 3.2 - 43.1），敏感性为23%，特异性为98%。患者的中位随访时间为4.0年（IQR 3.0 - 6.0；最长7.5年）。有SAS的患者随访期间中风或死亡风险为20.0%（95% CI 11.1 - 28.9），无SAS的患者为15.1%（95% CI 12.3 - 17.9）（p = 0.561）。严重SAS患者的住院时间更长（5.0天，SD 4.9 vs. 2.7天，SD 4.3，p = 0.035）。
本研究首次证实了在接受颈动脉血运重建治疗的患者中，尤其是在预防脑过度灌注的术后阶段，测量双臂血压差异的临床必要性。
