356 TCD 212 3 215 4 TCD 45 TCD 8 Ⅰ 21 Ⅱ 11 Ⅲ 5 4 45 6 2 Ⅰ 12 9 Ⅱ 3 7 1 Ⅲ 3 2 r =. 78 P <. 5 TCD Ⅰ Ⅱ Ⅲ 7 ± 23 85 ± 3 14 ± 32 cm /s 39 ± 1 46 ± 16 54 ± 17 cm /s 1. 17 ±. 2 1. 27 ±. 31 1. 43 ±. 36 49 ± 9 34 ± 7 cm /s. 66 ±. 8 P <. 1 5 ± 11 34 ± 1 cm /s. 68 ±. 12 P <. 1 P <. 1 TCD doi 11.3969 /j.issn.1672-5921.215.7.5 Evaluation of the hemodynamics of contralateral vertebral arteries with transcranial Doppler in patients with subclavian artery steal syndrome Huang Wei Yang Zhenyu Luo Ping Ruan Lijiang. Department of Ultrasound Baoan District Center Hospital of Shenzhen Shenzhen 51282 China Corresponding author Ruan Lijiang Email rljbti@ 163. com Abstract Objective To investigate the hemodynamic changes of contralateral vertebral arteries with transcranial Doppler TCD in patients with subclavian artery steal syndrome. Methods Forty-five outpatients or inpatients with subclavian artery stenosis or occlusion confirmed by TCD and color Doppler flow imaging CDFI and treated at Baoan District Center Hospital of Shenzhen from March 212 to April 215 were analyzed retrospectively. According to the TCD detection the degrees of intracranial arterial steal were divided into 4 groups non-blood steal n = 8 blood steal phase Ⅰ n = 21 phase Ⅱ n = 11 and phase Ⅲ n = 5 45 healthy subjects from Baoan District Central Hospital were used as a control group. The contralateral vertebral artery hemodynamic indexes of each blood steal group were detected respectively and they were compared with the control group. Results Of the patients without blood steal 6 patients had mild subclavian artery stenosis 2 had moderate stenosis of the patients with phase I blood steal 12 had mild subclavian artery stenosis 9 had moderate stenosis of the patients with phaseⅡblood steal 3 had moderate subclavian artery stenosis 7 had severe stenosis and 1 had occlusion of the patients with phase Ⅲ blood steal 3 had severe subclavian artery stenosis 2 had occlusion. The degree of blood steal was positively correlated with the lesion degree of subclavian artery stenosis r =. 78 51282 Email rljbti@ 163. com
357 P <. 5. TCD findings revealed that the contralateral vertebral artery systolic blood flow velocities in patients with phase Ⅰ Ⅱ and Ⅲ steal groups were 7 ± 23 85 ± 3 and 14 ± 32 cm/s respectively their mean flow velocities were 39 ± 1 46 ± 16 and 54 ± 17 cm /s respectively their pulsatility indexes were 1. 17 ±. 2 1. 27 ±. 31 and 1. 43 ±. 36 respectively and they were all significantly higher than 49 ± 9 34 ± 7 and. 66 ±. 8 cm /s of the control group all P <. 1 and 5 ± 11 34 ± 1 and. 68 ±. 12 cm/s of the non-blood steal group all P <. 1 and there were significant differences among the steal blood groups in each phase all P <. 1. Conclusion Detecting the hemodynamic indexes of contralateral vertebral arteries using TCD can preliminaryly assess the subclavian artery lesions and their steal degree. Key words Ultrasonography Doppler transcranial Ultrasound carotid artery Subclavian artery Steal TCDMR MRA 1 DSA CDFI 45 subclavian steal syndrome SSS TCD 1-2 TCD 5 SSS 1. 2 1-3 TCD CDFI TCD SSS SSS SSS 1 1. 1 2-4 212 3 1. 3 215 4 TCD CDFI 45 TCD 2 MHz 32 13 42 ~ 75 59 ± 11 33 12 5 5 1 45 TCD CDFI SSS 37 Ⅰ 21 16 5 V p V m 46 ~ 68 58 ± 1 18 V d PI 6 1 Ⅱ 11 8 3 45 ~ 75 6 ± 12 9 Philips ie Elite 3 2 2 Ⅲ 5 4 1 53 ~ 7 62 ± 1 4 2 1 1 8 4 4 32 13 41 ~ 72 59 ± 1 TCD EMS-9E - 4 MHz CDFI L11-3 C5-1 1 42 ~ 66 58 ± 11 2 1. 4 TCD 1 1 2 Ⅰ 1 45 3 Ⅱ
358 Ⅲ2 2. 1 TCD SSS CDFI 3 1. 5 TCD 1 TCD CDFI 2 ~ 3 mmhg 2 ~ 3 min TCD 8 - Ⅰ 21 6 12 2 9 Ⅱ 11 3 7 1 Ⅲ 5 3 2 1. 6 2 5-6 CDFI CDFI TCD CDFI r =. 78 P <. 5 1 V p 12 ~ 45 cm /s 2. 2 5 V p V m PI P <. 1 Ⅰ Ⅱ Ⅲ V p V m ~ 49% PI P <. 1 5% ~ 69% 7% ~ 99% 1% V p V m V d PI P >. 5 Ⅰ Ⅱ Ⅲ 1. 7 V p V m PI SAS 9. P <. 1 2 Ⅰ x - ± s TCD LSD-t SSS 1 ~ 3 Spearman 2. 3 P <. 5 2 x - ± s V p V m V d cm /s PI 45 49 ± 9 abcd 34 ± 7 abcd 26 ± 7. 66 ±. 8 abcd 8 5 ± 11 abcd 34 ± 1 abcd 26 ± 8. 68 ±. 12 abcd Ⅰ 21 7 ± 23 ab cd 39 ± 1 ab cd ab cd 24 ± 7 1. 17 ±. 2 Ⅱ 11 85 ± 3 abc d 46 ± 16 abc d 26 ± 1 1. 27 ±. 31 abc d Ⅲ 5 14 ± 32 abcd 54 ± 17 abcd 28 ± 11 1. 43 ±. 36 abcd F 1. 1 7. 75 3. 71 4. 21 P. 1. 6. 63. 73 V p V m V d a P <. 1 b P <. 1 Ⅰ c P <. 1 Ⅱ d P <.
359 1a 1b 1c 1d 2 3 图 1 右 锁 骨 下 动 脉 轻 度 狭 窄 患 者 TCD 表 现 1a 为 右 锁 骨 下 动 脉 近 端 轻 度 狭 窄 TCD, 表 现 为 血 流 速 度 显 著 增 高 ( 收 缩 期 峰 值 流 速 :166.5 cm/s), 反 向 切 迹 消 失 并 有 涡 流 杂 音 频 谱 ;1b 为 右 侧 椎 动 脉 TCD, 示 收 缩 峰 切 迹 频 谱 (Ⅰ 期 盗 血 );1c 为 右 侧 椎 动 脉 束 臂 试 验 前 后 TCD, 示 束 臂 试 验 后 收 缩 期 血 流 反 向 ;1d 为 健 侧 椎 动 脉 TCD 表 现, 示 血 流 速 度 轻 度 增 高,PI 增 高 并 波 峰 圆 钝 血 流 频 谱 图 2 Ⅱ 期 盗 血 患 者 健 侧 椎 动 脉 TCD 表 现, 示 血 流 速 度 增 高,PI 增 高 并 波 峰 圆 钝 血 流 频 谱 图 3 Ⅲ 期 盗 血 患 者 健 侧 椎 动 脉 TCD 表 现, 示 血 流 速 度 显 著 增 高,PI 增 高 并 波 峰 圆 钝 血 流 频 谱 1 SSS 1c 3 TCD CDFI SSS V p 2 5-7 - V p SSS SSS SSS 3 - - TCD - - 6-8 V m V d Ⅰ V m V p 3 9 Ⅱ Ⅲ 1 3 1 TCD V p CDFI
36 - PI TCD V p PI PI PI SSS SSS TCD PI PI 1. J. 24 37 2 139-143. PI 2. M. PI PI 22 81-2. SSS 3. J. 11 25 2 11 499-51. 4. SSS J. 214 11 8 397-41. 5. J. 212 9 1 41-42. 6. J. 11 214 27 1 16-18. 7. J. 29 26 2 212-214. 8 Tan TY Schminke Chen TY. Hemodynamic effect of subclavian steal phenomenon on contralateral vertebrd artery J. J Clin Ultrasound 26 34 2 77-81. 9. J. 26 22 8 583-585. TCD SSS 1. J. 21 18 6 441-446. 11. TCD 11-12. Ⅰ C. 21 32-37. 12. TCD CDFI J. 29 6 8 49-412. TCD CDFI SSS 215-5-14