Department of Neurology, Air Force Medical Center, PLA (People's Liberation Army), Beijing, China.
Department of Neurology, Zhejiang Hospital, Hangzhou, China.
Interv Neuroradiol. 2020 Jun;26(3):321-328. doi: 10.1177/1591019919897765. Epub 2020 Jan 22.
Subclavian steal syndrome results from hemodynamic impairment due to stenosis or occlusion of subclavian artery. Therefore, it is important for subclavian steal syndrome patients to assess hemodynamic status during endovascular therapy.
Eleven subclavian steal syndrome patients undergoing endovascular therapy attended this study. Pressure wire was used to measure trans-stenosis pressure difference (ΔP). Digital subtraction angiography, Transcranial Doppler and Electronic sphygmomanometer were introduced to assess stenotic rate, steal grade and inter-arm systolic pressure difference, respectively. Clinical symptoms and restenosis were followed up after endovascular therapy. The associations of ΔP with stenotic rate, inter-arm pressure difference, steal degree, clinic symptoms and restenosis were analyzed in this paper.
Prior to the therapy, ΔP moderately correlated with stenotic rate (r = 0.757, = 0.007) and inter-arm pressure difference (r = 0.701, = 0.016). ΔP was ≥6 mmHg in all patients, and 6-9 mmHg for grade 1 steal and ≥10 mmHg for grade 2 and 3 steals. After the therapy, all patients had technique success, and 10 patients had clinic success, and 1 patient appeared restenosis. ΔP was ≤3 mmHg and steal disappeared in the patients with clinical success. ΔP was 18 mmHg and grade 3 steal still existed in one patient without clinical success. One patient with 1 mmHg of ΔP after therapy appeared restenosis in the follow-up.
The trans-stenosis pressure difference is closely related to steal degree and clinical symptoms. The measurement of hemodynamic status by pressure wire is very useful to guide endovascular therapy in subclavian steal syndrome patients. However, the restenosis may still occur, even though the hemodynamic impairment is improved.
锁骨下窃血综合征是由于锁骨下动脉狭窄或闭塞导致的血流动力学障碍引起的。因此，对于锁骨下窃血综合征患者，在血管内治疗期间评估血流动力学状态非常重要。
本研究纳入了 11 例接受血管内治疗的锁骨下窃血综合征患者。使用压力导丝测量跨狭窄压差（ΔP）。数字减影血管造影、经颅多普勒超声和电子血压计分别用于评估狭窄率、窃血程度和臂间收缩压差。血管内治疗后随访临床症状和再狭窄情况。分析了ΔP与狭窄率、臂间压差、窃血程度、临床症状和再狭窄之间的关系。
在治疗前，ΔP 与狭窄率（r=0.757，P=0.007）和臂间压差（r=0.701，P=0.016）中度相关。所有患者的ΔP均≥6mmHg，1 级窃血为 6-9mmHg，2 级和 3 级窃血为≥10mmHg。治疗后，所有患者均获得技术成功，10 例患者获得临床成功，1 例患者出现再狭窄。临床成功的患者ΔP≤3mmHg，窃血消失。1 例无临床成功的患者ΔP为 18mmHg，仍存在 3 级窃血。1 例治疗后ΔP为 1mmHg 的患者在随访中出现再狭窄。
跨狭窄压差与窃血程度和临床症状密切相关。压力导丝测量血流动力学状态对指导锁骨下窃血综合征患者的血管内治疗非常有用。然而，即使血流动力学得到改善，再狭窄仍可能发生。
