在普通人群和接受脑血管双工超声(CDUS)检查的患者中,锁骨下盗血(定义为逆行/双向椎动脉血流)的患病率是可变的。这是迄今为止最大的研究,目的是分析1年内5615次CDUS检查中双重提示的锁骨下盗血的发生率,并检查其临床意义。
分析1年期间进行的所有连续CDUS检查是否存在锁骨下盗血。测试的指示,存在大脑后循环/锁骨下动脉盗血症状,并分析了锁骨下动脉盗血的任何干预措施。
在5615例CDUS检查中,共有171例(3.1%)被发现有锁骨下盗血(双重建议)。117(2.1%)具有逆行流动,54(1%)具有双向流动。171人中,104人(60.8%)为左侧。CDUS的适应症为颈动脉内膜切除术后/颈动脉支架置入术监测39例患者(22.8%),监测76例患者颈动脉狭窄进展(44.4%),短暂性脑缺血发作/卒中26例(15%),无症状筛查/颈动脉杂音18例(10.5%),12例(7%)患者出现孤立性脑后循环症状。总共63%的患者伴有>50%的颈动脉狭窄。无症状患者的平均臂多普勒压力梯度为32.2mmHg,而有后循环症状的患者为37mmHg(P=.3254)。逆行,顺行和双向血流患者的平均收缩压之间存在显着差异(105mmHgvs146mmHgvs134mmHg,分别,P<.0001)。除一名患者外,所有逆行血流患者的锁骨下狭窄或闭塞均>50%(117名中有100名次全/完全闭塞)。同时,54例双向血流患者中有52例锁骨下狭窄>50%(54例次全/完全闭塞患者中有6例),而2例患者狭窄正常/<50%(P<0.0001)。总的来说,171例患者中有26例(15.2%)对致残症状进行了干预。在所有干预措施中,有26种中有11种是针对致残性手臂跛行,171例患者中只有10例(5.8%)接受了后循环致残症状干预,除1例外,所有患者的症状均完全缓解.在平均18个月的后期随访(范围:1-37个月),没有晚期严重卒中,只有两个腔隙性梗死(与锁骨下动脉盗血无关)。还有7人死亡,与中风无关。
在接受CDUS的患者中,锁骨下盗血的发生率相对较少。这些患者大多无症状,可以保守治疗,只有少数人可能需要对症状缓解良好的致残症状进行干预。
The prevalence of subclavian steal (defined as retrograde/bidirectional vertebral artery flow) in the general population and in patients undergoing cerebrovascular duplex ultrasound (CDUS) examinations is variable. This is the largest study to date to analyze the incidence of duplex-suggested subclavian steal in 5615 CDUS examinations over a 1-year period and to examine its clinical implications.
All consecutive CDUS examinations performed over a 1-year period were analyzed for the presence of subclavian steal. Indications of testing, presence of posterior cerebral circulation/subclavian steal symptoms, and any interventions for subclavian steal were analyzed.
A total of 171 of 5615 (3.1%) CDUS examinations were found to have subclavian steal (duplex-suggested). One hundred seventeen (2.1%) had retrograde flow and 54 (1%) had bidirectional flow. Of 171, 104 (60.8%) were left sided. Indications for CDUS were post-carotid endarterectomy/carotid artery stenting surveillance in 39 patients (22.8%), surveillance for progression of carotid stenosis in 76 patients (44.4%), transient ischemic attack/stroke in 26 patients (15%), asymptomatic screening/carotid bruit in 18 patients (10.5%), and isolated posterior cerebral circulation symptoms in 12 patients (7%). A total of 63% patients had associated >50% carotid stenosis. The mean arm Doppler pressure gradient was 32.2 mm Hg for asymptomatic patients vs 37 mm Hg for patients with posterior circulation symptoms (P = .3254). There were significant differences between the mean systolic arm pressure for patients with retrograde vs antegrade vs bidirectional flow (105 mm Hg vs 146 mm Hg vs 134 mm Hg, respectively, P < .0001). All patients with retrograde flow had >50% subclavian stenosis or occlusion (100 of 117 had subtotal/total occlusion) except for one patient. Meanwhile, 52 of 54 patients with bidirectional flow had >50% subclavian stenosis (6 of 54 with subtotal/total occlusion), whereas two patients were normal/<50% stenosis (P < .0001). Overall, 26 of 171 patients (15.2%) had interventions for disabling symptoms. Eleven of 26 of all interventions were for disabling arm claudication, and only 10 of 171 patients (5.8%) were intervened for disabling posterior circulation symptoms with complete resolution of symptoms in all except one. At a late follow-up with a mean of 18 months (range: 1-37 months), there was no late major stroke with only two lacunar infarcts (not subclavian steal related). There were also seven late deaths, none stroke related.
The incidence of subclavian steal in patients who undergo CDUS is relatively rare. Most of these patients are asymptomatic and can be treated conservatively, and only a few may need intervention for disabling symptoms with good symptom resolution.