Saalouke M G, Perry L W, Breckbill D L, Shapiro S R, Scott L P
Am J Cardiol. 1978 Jul;42(1):97-101. doi: 10.1016/0002-9149(78)90991-8.
Fifteen children, aged 0.3 to 10.5 years (mean 3.8 years) after repair of coarctation of the aorta, underwent cerebral arteriography as part of postoperative catheterization. Four manifested central nervous system symptoms postoperative catheterization. Four manifested central nervous system symptoms postoperatively: Two had persistent headaches, one had exercise-induced hemianopsia and one had major motor seizures. All four had greater blood pressure in the right arm than in the left and evidence of subclavian steal, with retrograde filling of the left vertebral and left subclavian arteries on selective right vertebral arteriography. Ligation of the left vertebral artery in three patients and left subclavian graft arterioplasty in one resulted in disappearance of symptoms. None of the 11 asymptomatic patients manifested cerebrovascular anomalies, and no patient in the series had berry aneurysm. This study suggests that patients with central nervous system symptoms and a disparity of blood pressure in the arms after surgery for coarctation of the aorta should be evaluated carefully to exclude subclavian steal as the cause of the symptoms.
15名年龄在0.3至10.5岁（平均3.8岁）的主动脉缩窄修复术后患儿，作为术后导管插入术的一部分接受了脑血管造影。4名患儿在术后导管插入术后出现中枢神经系统症状。4名患儿术后出现中枢神经系统症状：2名持续头痛，1名运动诱发偏盲，1名出现大发作性癫痫。这4名患儿右臂血压均高于左臂，并有锁骨下动脉盗血证据，选择性右椎动脉造影显示左椎动脉和左锁骨下动脉逆行充盈。3例患儿结扎左椎动脉，1例进行左锁骨下动脉移植血管成形术，症状消失。11名无症状患儿均未表现出脑血管异常，该系列中无患儿患有浆果样动脉瘤。本研究表明，主动脉缩窄手术后出现中枢神经系统症状且双臂血压存在差异的患者，应仔细评估以排除锁骨下动脉盗血作为症状的原因。
