Clinical And Imaging Features Of Carotid Steal Syndrome

[Objective]1?There are few reports about the carotid steal syndrome,the type of the disease is single,the clinical manifestations are complex and changeable.the clinical symptoms are not consistent with the vascular lesions,and the diagnosis rate is low.We analyze the clinical and imaging features of carotid steal syndrome to provide reference for clinical diagnosis.2?We analyze the establishment of collateral circulation and compensation methods of carotid steal syndrome in order to evaluate the prognosis of patients with carotid steal syndrome.3?Carotid endarterectomy and carotid artery stenting are the two main treatments for patients with carotid steal syndrome.Through the analysis of two kinds of treatment methods,we evaluate the degree of circulation improvement in patients with carotid steal syndrome,to provide evidence for treatment.[Methods]1?11 patients with carotid steal syndrome were collected from March 2016 to March 2017 in the Second Affiliated Hospital of Kunming Medical University.2?The clinical data of all subjects were collected,including medical history and risk factors,such as age,smoking,drinking,hypertension,diabetes,hyperlipidemia,hyperhomocysteinemia,stroke history and so on.On the second day of admission,fasting venous blood was taken to measure fasting blood glucose,blood lipid,homocysteine,liver and kidney function and so on.3?During the hospitalization,11 patients were examined by color Doppler ultrasound or transcranial Doppler,cranial CTA or MRA,and cerebral angiography.4?In the case of carotid steal syndrome,9 patients underwent carotid endarterectomy or carotid artery stenting in the hospital,and only the conservative treatment was performed in 2 cases.5?11 patients were followed up for 3 months,6 months and 1 years after discharge.The follow-up included:(1).The.mRs scale assessment;(2).Whether the occurrence of ischemic cerebrovascular events;(3).The intake of the grade 2 prevention drugs of stroke;(4).The management of vascular risk factors.[Results]1?11 cases of CSS patients were included,of which 7 cases were male(63.6%),4 cases were female(36.4%),mean age is(62.5 + 4.2)years old.All the patients had the risk factors of cerebrovascular disease:history of smoking in 6 cases(54.5%),drinking history in 2 cases(18.2%),hypertension in 9 cases(81.8%),diabetes in 3 cases(27.3%),hyperlipidemia in 8 cases(72.7%),hyperhomocysteinemia in 10 cases(90.9%),the history of stroke in 3 cases(27.3%).2?Of 11 subjects,the internal carotid artery occlusion in 2 cases(18.2%),severe stenosis of internal carotid artery in 9 cases(81.8%).The lesions of unilateral internal carotid artery in 7 cases(63.6%),including 1 cases of occlusion,6 cases of severe stenosis(1 cases caused by dissection).Bilateral internal carotid artery lesions in 4 cases(36.4%)(1 cases was bilateral occlusion,the other 3 cases had severe stenosis on one side and moderate stenosis in other side).3?The clinical manifestations of carotid steal syndrome are watershed infarction and transient ischemic attack.In this case,5 patients with posterior circulation transient ischemic attack(45.5%),posterior circulation cerebral infarction in 2 cases(18.2%),anterior circulation transient ischemic attack in 2 cases(18.2%),and anterior circulation infarctionn 2 cases(18.2%).Digital subtraction angiography showed that there were 18 internal carotid artery and common carotid artery in the lesion,and the 13 involved the initial segment of the internal carotid artery.11 cases of patients with collateral circulation were established,primary collateral circulation in 11 cases(100%),Secondary collateral circulation in 4 cases(36.4%),the third collateral circulation in 1 cases(9.1%).The ASITN score of grade 0-2 in 1 patients(9.1%),grade 3 in 4 cases(n = 36.4%),and grade 4 in 6 patients(54.5%);the anterior communicating artery was opened in 4 patients(36.4%),and the posterior communicating artery was opened in 6 patients(54.5%).The anterior and posterior communicating arteries were opened in 1 cases(9.1%).4.All 11 patients were treated with drug therapy on the basis of risk factor management,including 9 cases of severe stenosis underwent surgical treatment,5 patients underwent carotid artery stenting,4 patients underwent carotid endarterectomy,2 cases of occlusion were only given conservative treatment.All patients were followed up for 3 months,6 months and 1 years after discharge.Symptoms like stroke were found in 2 cases of patients with carotid artery stent implantation in different periods after discharge.Of them,there were 1 patients who suffered from recurrent anterior circulation ischemic attack after a month of stopping antiplatelet aggregation and statin treatment by themselves;1 case still had the symptoms of stroke occurred in the 6 months after discharge on the premise of routine medication.There were no stroke in 4 patients with carotid endarterectomy followed up for at least 1 years after surgery.2 cases of patients with carotid artery occlusion still had intermittent dizziness attacks after discharge,multiple cranial MRI examination revealed multiple lacunar cerebral infarction.[Conclusion]1?Most of the internal carotid artery lesions in patients with the carotid artery steal syndrome lied in extracranial segment.Carotid steal syndrome is usually manifested as anterior or posterior circulation transient ischemic attack or watershed infarction,The clinical manifestation is not consistent with the pathological vessels.Because of the serious stenosis or occlusion of the carotid artery,the compensation of collateral circulation plays an important role,digital subtraction angiography is a definite diagnostic method.2?Hypoperfusion may be the pathogenesis of carotid steal syndrome.Carotid artery stenting or carotid endarterectomy is the current effective treatment for carotid steal syndrome.The prognosis of carotid artery stenting and carotid endarterectomy in patients with carotid steal syndrome is good in the short term,The long-term effect of carotid endarterectomy may be superior to carotid artery stenting.3?For patients with carotid artery occlusion of carotid artery steal syndrome,the effect of conservative treatment is not good,and whether recanalization can become the best treatment for internal carotid artery occlusion still need further study.