应用彩色多普勒超声评估锁骨下动脉狭窄合并不同程度椎动脉狭窄患者的窃血类型。

回顾性连续纳入2013年1月至2017年10月于首都医科大学宣武医院就诊，通过彩色多普勒血流显像（CDFI）联合经颅彩色多普勒超声（TCCS）和（或）经颅多普勒超声（TCD）筛查，并经CT血管造影（ CTA）或数字减影血管造影（DSA）检查确诊为锁骨下动脉狭窄（≥50%）或闭塞的患者共503例。根据椎动脉血流频谱特征将锁骨下动脉窃血（SAS）分为Ⅰ型（隐匿型）、Ⅱ型（部分型）和Ⅲ型（完全型）；根据锁骨下动脉与椎动脉病变程度将503例患者分为50%≤锁骨下动脉狭窄<70%组254例，锁骨下动脉狭窄≥70%组249例，50%≤椎动脉狭窄<70%组391例，椎动脉狭窄≥70%及全程纤细组112例。分析不同锁骨下动脉狭窄程度及合并不同程度椎动脉狭窄的患者SAS分型的差异性。

503例患者SAS分型中，Ⅰ型最多，占50.3%（253/503）、Ⅱ型占18.9%（95/503）、Ⅲ型占26.0%（131/503）、无SAS患者4.8%（24/503）。50%≤锁骨下动脉狭窄<70%组与锁骨下动脉狭窄≥70%组间SAS分型比较，差异有统计学意义（P<0.001），其中50%≤锁骨下动脉狭窄<70%组以Ⅰ型居多（230/254，90.6%），锁骨下动脉狭窄≥70%组以Ⅲ型居多（131/249，52.6%）。50%≤锁骨下动脉狭窄<70%组内，50%≤椎动脉狭窄<70%与椎动脉狭窄≥70%及全程纤细患者SAS分型比较，差异无统计学意义（P=0.184），2组均以Ⅰ型SAS居多（91.9% vs 84.1%）。锁骨下动脉狭窄≥70%组内，50%≤椎动脉狭窄<70%组与椎动脉狭窄≥70%及全程纤细组的SAS分型比较，差异有统计学意义（P<0.001），其中50%≤椎动脉狭窄<70%组中Ⅲ型SAS占比较椎动脉狭窄≥70%及全程纤细组高（63.0% vs 25.0%），2组比较差异有统计学意义（P<0.001）；50%≤椎动脉狭窄<70%组中Ⅰ型SAS占比较椎动脉狭窄≥70%及全程纤细组低（2.2% vs 27.9%），2组比较差异有统计学意义（P<0.001）。

合并椎动脉狭窄≥70%及全程纤细，可使锁骨下动脉狭窄≥70%患者的SAS分型程度减低，锁骨下动脉狭窄合并不同程度的椎动脉狭窄患者可能存在锁骨下动脉狭窄程度与SAS分型程度的不一致性，应在临床超声检查评估中加以关注。

To evaluate the correlation between the degree of subclavian artery (SA) stenosis with vertebral artery (VA) stenosis and the type of subclavian artery steal (SAS) by color Doppler ultrasonography (CDU).

A total of 503 patients with SA stenosis≥ 50% or occlusion with varying degrees of VA stenosis were consecutively enrolled from January 2013 to October 2017. All patients underwent CDU screening and confirmed by CT angiography (CTA) or digital subtraction angiography (DSA). According to the flow waveform of the VA, SAS was divided into three types: I (latent type), II (partial type), and III (complete type). Based on the degree of SA stenosis, the patients were divided into two groups: patients with SA stenosis ≥ 50% to<70% (n=254) and those with SA stenosis ≥ 70% (n=249). Based on the degree of VA stenosis, the patients were also divided into two groups: patients with VA stenosis ≥ 50% to<70% (n=391) and those with VA stenosis ≥ 70% (n=112). The correlation between the degree of SA stenosis with VA stenosis and the type of SAS was analyzed.

Among all 503 patients, type I SAS was the most common type, accounting for 50.3% (253/503), while types II and III accounted for 18.9% (95/503) and 26.0% (131/503), respectively; the percentage of patients with no SAS was 4.8% (24/503). There was a significant difference in the distribution of SAS types between patients with SA stenosis ≥ 50% to<70% and patients with SA stenosis ≥ 70% (P<0.01), with type I SAS being the most common type in patients with SA stenosis ≥ 50% to<70% (90.6%, 230/254) and type III being the predominant type in patients with SA stenosis ≥ 70%. In patients with SA stenosis ≥ 50% to<70%, there was no significant difference in the distribution of SAS types between patients with VA stenosis ≥ 50% to<70% and patients with VA stenosis ≥ 70% (P=0.184), with type I being the predominant SSA type in both groups. In patients with SA stenosis ≥ 70%, there was a significant difference in the distribution of SAS types between patients with VA stenosis ≥ 50% to<70% and patients with VA stenosis ≥ 70% (P<0.001); the percentage of patients with type III SAS was significantly higher in patients with VA stenosis≥50% to<70% than in patients with VA stenosis ≥70% (63.0% vs 2 5.0%, P<0.001), while he percentage of patients with type I SAS was significantly lower in patients with VA stenosis ≥50% to<70% than in patients with VA stenosis ≥ 70%.

The presence of VA stenosis ≥ 70% in patients with SA stenosis ≥70% can alter the distribution of SAS types. In patients with SA stenosis with different degrees of VA stenosis, there may be inconsistency between the degree of SA stenosis and the classification of SAS, which should be paid attention to in clinical ultrasound evaluation.