Ahmed Mohamed A, Parwani Divya, Mahawar Anmol, Gorantla Vasavi Rakesh
Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD.
Cureus. 2022 Mar 19;14(3):e23312. doi: 10.7759/cureus.23312. eCollection 2022 Mar.
Subclavian artery calcification (SAC) affects 2% of the population and presents a serious risk of developing into subclavian steal syndrome (SSS). Risk factors for plaque formation of the subclavian artery include diabetes, hypertension, and smoking. While SAC generally presents as asymptomatic, symptoms in severe cases may include numbness, pain at rest, and ischemic gangrene. Patients with severe SSS are at high risk of developing neurological symptoms as a result of vertebrobasilar insufficiency affecting posterior cerebral perfusion. On physical examination, SSS is preliminarily diagnosed from bilateral inter-arm systolic blood pressure discrepancy (>10 mmHg), which can be further confirmed with vascular imaging. Duplex ultrasound (DUS) is a cost-effective and non-invasive baseline technique for visualizing luminal stenosis and quantifying peak systolic velocity (PSV). Computed tomography angiography (CTA) provides high-quality, fast, three-dimensional (3D) imaging at the cost of introducing nephrotoxic contrast agents. Magnetic resonance angiography (MRA) is the safest 3D imaging modality, without the use of X-rays and contrast agents, that is useful in assessing plaque characteristics and degree of stenosis. DUS-assisted digital subtraction angiography (DSA) remains the gold standard for grading the degree of stenosis in the subclavian artery and determining the distance between the puncture site and lesion, which can be carried out in a combined procedure with endovascular management strategies. The fundamental treatment options are surgical and endovascular intervention. Endovascular treatment options include percutaneous transluminal angiography (PTA) for recanalization of the stenosed vessel and permanent balloon stenting to prevent collapse after PTA. Overall, the benefits of endovascular management encompass faster recovery, lower stenosis recurrence rate, and lower incidence of complications, making it the treatment of choice in low-risk patients. Surgical interventions, although more complex, are considered gold-standard treatment options.
锁骨下动脉钙化（SAC）影响2%的人口，并且存在发展为锁骨下动脉窃血综合征（SSS）的严重风险。锁骨下动脉斑块形成的风险因素包括糖尿病、高血压和吸烟。虽然SAC通常无症状，但严重病例的症状可能包括麻木、静息痛和缺血性坏疽。严重SSS患者由于椎基底动脉供血不足影响后循环灌注而有发生神经症状的高风险。体格检查时，SSS初步通过双侧上臂收缩压差异（>10 mmHg）诊断，可通过血管成像进一步确诊。双功超声（DUS）是一种经济有效且无创的基线技术，用于观察管腔狭窄和量化收缩期峰值流速（PSV）。计算机断层血管造影（CTA）以引入肾毒性造影剂为代价提供高质量、快速的三维（3D）成像。磁共振血管造影（MRA）是最安全的3D成像方式，无需使用X射线和造影剂，有助于评估斑块特征和狭窄程度。DUS辅助数字减影血管造影（DSA）仍然是锁骨下动脉狭窄程度分级以及确定穿刺部位与病变之间距离的金标准，可与血管内治疗策略联合进行。基本的治疗选择是手术和血管内介入。血管内治疗选择包括经皮腔内血管成形术（PTA）使狭窄血管再通以及永久性球囊支架置入以防止PTA后血管塌陷。总体而言，血管内治疗的益处包括恢复更快、狭窄复发率更低以及并发症发生率更低，使其成为低风险患者的首选治疗方法。手术干预虽然更复杂，但被认为是金标准治疗选择。
