Hemodynamic changes and steal patterns in serious stenosis or occlusion of the subclavian artery or brachiocephalic arterial trunk
ZHANG Xiong-wei LU Qi ZHANG Yi-shan MA Wei-min WANG Cui-yu LI Man JIN Wen-jing WEN Xin.Department of Neurology,General Hospital of the Second Artillery of Chinese PLA,Beijing 100088,China
Objective To explore the cerebral hemodynamic changes and steal patterns in patients with serious stenosis or occlusion of the subclavian artery(SubA)or brachiocephalic arterial trunk(BCAT).Methods Sixty five patients determined to be serious stenosis or occlusion in the proximal SubA or BCAT by digital substraction angiography(DSA)or carotid color Doppler ultrasound were measured by transcranial Doppler(TCD)ultrasound and carotid continuous-wave Doppler(CWD) ultrasound.Results Among the 46 cases with stenosis,25 were found to have serious focal stenosis flow in the SubA or BCAT.No blood flow signal of the affected side SubA or BCAT was found in 19 patients with occlusion.CWD ultrasound showed abnormal blood flow waveforms manifesting low velocity of flow and pulsatility in the distal SubA, ulnar artery and radial artery of 30 cases;no blood flow signal of the affected side radial artery was detected in 7 cases;high resistance waveforms of the distal artery remained in 28 cases,but blood flow velocity and puisatility index were lower than the same contralateral artery.TCD and CWD ultrasound showed vertebral artery-vertebral artery steal in all the cases,basilar artery-vertebral artery steal in 30 of all the cases,occipital artery-vertebral artery steal in 14 of all the cases and anterior circulation steal in 5 cases with pathological changes in the BCAT. Conclusion Both TCD and CWD ultrasound are helpful for the understanding of hemodynamic changes and steal patterns in patients with serious stenosis or occlusion of the SubA or BCAT.They shall provide important and objective evidence for definitely diagnosing and determining causes of vertebrobasilar insufficiency and clinically deepening into the pathogenesis of ischemic cerebrovascular diseases.
【CateGory Index】： R543.5