Bajko Zoltan, Motataianu Anca, Stoian Adina, Barcutean Laura, Andone Sebastian, Maier Smaranda, Drăghici Iulia-Adela, Cioban Andrada, Balasa Rodica
Department of Neurology, University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania.
First Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania.
J Clin Med. 2021 Nov 10;10(22):5237. doi: 10.3390/jcm10225237.
There are no published clinical studies regarding the prevalence of subclavian steal among acute ischemic stroke patients. The aim of this study was to evaluate the prevalence and clinical significance of subclavian steal among a large number of consecutive ischemic stroke patients.
We reviewed the medical records of 2192 consecutive cases of acute ischemic stroke at a tertiary neurology clinic in Targu Mures, Romania, between 2018 and 2020. In total, 47 patients (2.2%) were diagnosed with subclavian steal phenomenon/syndrome.
Stroke patients with associated steal phenomenon were significantly younger (64.2 ± 11.1 versus 70.2 ± 12.8, = 0.005) and predominantly male (68.1%). From among the 47 patients with subclavian steal phenomenon, nine (19.1%) presented stroke symptomatology in the vertebrobasilar territory. Overall, 83.3% of the stroke patients with associated steal phenomenon presented cerebral infarction and 16.7% presented TIA. There was no difference between groups regarding the affected vascular territory (VB versus carotid). Large artery atherosclerosis was more frequent in the stroke group with associated steal phenomenon (81.3% versus 43.5%, = 0.0033). The NIHSS score at admission was higher in the patient group with associated steal phenomenon, but there was no difference in mRS at discharge. Associated carotid artery occlusion was more frequent in the stroke group with steal phenomenon ( < 0.01). Smoking and peripheral arteriopathy were more frequent in the patient group with associated steal phenomenon. Of the nine symptomatic patients, five underwent revascularization treatment.
The prevalence of subclavian steal phenomenon among acute ischemic stroke patients was not higher than in other cohorts with heterogenous peripheral vascular pathologies. Similar to the general population, in acute ischemic stroke patients, the associated subclavian steal behaved like a benign hemodynamical condition, without severe consequences.
目前尚无关于急性缺血性卒中患者锁骨下动脉盗血患病率的已发表临床研究。本研究的目的是评估大量连续性缺血性卒中患者中锁骨下动脉盗血的患病率及其临床意义。
我们回顾了2018年至2020年间罗马尼亚特尔古穆列什一家三级神经科诊所2192例连续性急性缺血性卒中病例的病历。共有47例患者（2.2%）被诊断为锁骨下动脉盗血现象/综合征。
伴有盗血现象的卒中患者明显更年轻（64.2±11.1岁对70.2±12.8岁，P = 0.005），且男性占主导（68.1%）。在47例有锁骨下动脉盗血现象的患者中，9例（19.1%）出现椎基底动脉区域的卒中症状。总体而言，伴有盗血现象的卒中患者中83.3%出现脑梗死，16.7%出现短暂性脑缺血发作（TIA）。两组在受累血管区域（椎基底动脉对颈动脉）方面无差异。伴有盗血现象的卒中组中大动脉粥样硬化更为常见（81.3%对43.5%，P = 0.0033）。伴有盗血现象的患者组入院时美国国立卫生研究院卒中量表（NIHSS）评分更高，但出院时改良Rankin量表（mRS）评分无差异。伴有盗血现象的卒中组中颈动脉闭塞更为常见（P<0.01）。伴有盗血现象的患者组中吸烟和外周动脉病变更为常见。9例有症状的患者中，5例接受了血运重建治疗。
急性缺血性卒中患者中锁骨下动脉盗血现象的患病率并不高于其他伴有外周血管病变异质性的队列。与一般人群相似，在急性缺血性卒中患者中，相关的锁骨下动脉盗血表现为一种良性血流动力学状况，无严重后果。
