Clinical Research On Interventional Diagnosis And Treatment Of Subclavian Artery Stenosiss

Objective To analyse the clinical characteristics of subclavian artery stenosis,steal blood caused by subclavian artery stenosis and collateral compensatory pathways with digital subtraction angiography in patients with subclavian artery stenosis; To explore the relation between posterior circulation ischemia symptoms and severity of subclavian artery stenosis,steal blood pathways,collateral compensation pathways; To evaluate the effect of intervention therapy for the subclavian artery stenosis.Methods The clinical data of 48 patients with subclavian artery stenosiss(?50%) conformed by digital subtraction angiography were analyzed retrospectively, and summarize the clinical features of subclavian artery stenosis,steal blood and collateral compensatory pathways caused by subclavian artery stenosis; These patients were divided into symptomatic group(26 cases) and asymptomatic(22cases) according to the presence or absence of posterior circulation ischemic,the relation between posterior circulation ischemia symptoms and severity of subclavian artery stenosis,steal blood pathways,collateral compensatory pathways was analysed. The clinical data of 18 patients who underwent percutaneous transluminal stent placement were analyzed retrospectively.Results DSA show that subclavian artery stenosis was in the left side 36 cases(75%), in the right side 10 cases(21%),double side in 2 cases(4%). DSA show that subclavian artery stenosis was in the moderate stenosis group 24 cases which including intracranial compensatory pathways was open 10 cases(42%), no vertebral artery-vertebral artery-subclavian artery steal blood and extracranial compensatory way was open; DSA show that subclavian artery stenosis was in the severe stenosis group 24 cases which including the vertebral artery- vertebral artery- subclavian artery way was open 9 cases(38%), intracranial compensatory way was open 6 cases(25%), the vertebral artery- vertebral artery- subclavian artery way coexist in intracranial compensatory way were open 4 cases(17%), extracranial compensatory way was open in 2 cases(8%), there were significant differences for steal blood and compensatory collateral pathways in these two groups of patients(P <0.05). There were no significant differences for subclavian artery stenosis degree and vertebral artery-vertebral artery-subclavian artery steal blood pathways in posterior circulation ischemia group and no posterior circulation ischemia group(P > 0.05), there were significant differences for compensatory collateral in these two groups of patients(P <0.05). The success rate of surgical techniques was 100% for the 18 patients, there were all no complication to occure but 1, the clinical symptoms after the treatment were improved in all patients, double arm systolic blood pressure differential < 10 mmHg, during the follow- up period lasting for 3 to 33 months in 12 patients were followed up for, the clinical symptoms were no recurrence, the subclavian arteries were no restenosis confirmed by TCD and(or) CTA.Conclusion 1. SAS was mainly caused by atherosclerosis and mainly in the left side, the steal blood and collateral compensatory pathways whether open or not was associated with the degree of SAS; 2. The posterior circulation ischemia symptoms caused by SAS were not associated with the degree of SAS and the vertebral artery-vertebral artery-subclavian artery steal blood pathway, however they were associated with collateral compensatory; 3.For the SAS, the PTSP is a safe and effective treatment.