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《Chinese Journal of Neurology》 2004-02
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The association between the clinical performance and steal phenomena in patients with subclavian artery occlusive disease: a transcranial Doppler and digital substract angiography study

GAO Shan *, HUANG Yi-ning, LIU Jun-yan, WANG Bo. *Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China  
Objective To analyse the association between the clinical performance and degree of steal phenomena with transcranial Doppler (TCD) and digital substract angiography (DSA) in patients with subclavian artery (Sub-A) occlusive disease. Methods Totally 152 patients with Sub-A occlusive disease in the proximal segment before vertebral artery (VA) origin with TCD (45 patients performed with both TCD and DSA) were studied. Sub-A stenosis was defined if the systolic flow velocity was more than 120 cm/s with disturbed flow and murmur, and also the Sub-A occlusion was defined if there was no flow in proximal Sub-A and the low flow found in distal segment. According to the direction of ipsilateral VA (ip-VA), the subclavian steal syndrome (SSS) were defined as no steal (normal direction), stage Ⅰ (deceleration in systole), stage Ⅱ (alteration flow with reversed flow in systole and normal flow in diastole) and stage Ⅲ (reversed flow completely). The steal pathway was defined as basilar artery steal pathway (with steal waveform in basilar artery (BA)) or non-basilar artery steal pathway (normal direction in BA). The severity of occlusive disease of Sub-A on DSA was classified as 50%-74%, 75%-95%, and 95% according to the reduction of lumen area. Results (1) Among the 152 patients, 96 (64%) had symptoms (76% with VBI, 9% with ischemic symptom on ipsilateral arm and 14% with both). 83% of patients had systolic blood pressure difference more than 20 mm Hg between bilateral arms, but only 33% of patients had diastolic blood pressure difference more than 20 mm Hg (P 0.05). (2)TCD vs DSA: there was a significant association between the severity of subclavian artery stenosis and degree of VA steal in 45 patients performed with both TCD and DSA. (3) Association between vertebrobasilar ischemia (VBI) and severity of VA steal phenomena or basilar artery steal pathway: subclavian artery stenosis were found in 86% vessels (177/206) and the occlusion were found in 14% (29/206 vessels). 34.2% of patients had no steal phenomena, 19.9% had steal stage Ⅰ, 15.8% had steal stage Ⅱ and 30.1% had steal stage Ⅲ. A total of 52 patients had basilar artery steal pathway. There was no significant association between the VBI and the severity of steal phenomena (P=0.54), but significant difference with the basilar artery steal pathway (P0.05). Conclusions (1) TCD is a sensitive and reliable method for evaluating the steal phenomena in patients with subclavian artery stenosis. (2) The degree of steal phenomena was associated with the severity of stenosis. (3) The VBI was not associated with the degree of steal phenomena, it may associated with the steal pathway and accompany with multiple arteries stenosis.
【CateGory Index】: R543
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