Mochizuki A, Motoyoshi Y, Sonoo M, Matsumura K, Shimizu T
Department of Neurology, School of Medicine, Teikyo University.
Rinsho Shinkeigaku. 1997 Mar;37(3):257-60.
The subclavian steal syndrome is known to steal blood flow from the vertebrobasilar system. However, we experienced a case of subclavian artery occlusion presenting transient ischemic attacks in left internal carotid system. A left handed 41-year-old man developed transient dysarthria and right hemiparesis including face several times when he physically used his arms. He had no symptoms of the vertebrobasilar system. A brain MRI revealed an old cerebral lacuna at the left putamen supplied by perforating arteries of the middle cerebral artery. The angiography demonstrated a complete occlusion of the proximal portion of the left subclavian artery without a reverse flow from the vertebral artery. Instead, descending cervical branches and deep cervical branches of the ipsilateral external carotid artery supplied collateral pathways to the occluded subclavian artery. On the basis of above observations, we speculated that he developed symptoms of the internal carotid system due to the steal through the collateral network of the cervical arteries directed to the subclavian artery. We should consider not only the vertebrobasilar system but also the internal carotid system, especially its cervical artery network, when exploring collateral pathways for the subclavian steal syndrome.
锁骨下动脉盗血综合征已知会从椎基底动脉系统窃取血流。然而，我们遇到了一例锁骨下动脉闭塞导致左颈内动脉系统出现短暂性脑缺血发作的病例。一名41岁的左利手男性在体力活动手臂时多次出现短暂性构音障碍和包括面部在内的右侧偏瘫。他没有椎基底动脉系统的症状。脑部MRI显示左侧壳核有一个由大脑中动脉穿支供应的陈旧性脑腔隙。血管造影显示左锁骨下动脉近端完全闭塞，且无椎动脉逆流。相反，同侧颈外动脉的颈降支和颈深支为闭塞的锁骨下动脉提供了侧支循环途径。基于上述观察结果，我们推测他出现颈内动脉系统症状是由于通过指向锁骨下动脉的颈部动脉侧支网络发生了盗血。在探索锁骨下动脉盗血综合征的侧支循环途径时，我们不仅应考虑椎基底动脉系统，还应考虑颈内动脉系统，尤其是其颈部动脉网络。
