模拟短暂性脑缺血发作的锁骨下动脉盗血综合征非典型表现：血管造影相关的成功血管内治疗——一例病例报告

文献信息

中文摘要

背景： 锁骨下动脉盗血综合征是一种少见的血管疾病，由椎动脉起始部近端的锁骨下动脉狭窄或闭塞引起。其典型表现为椎基底动脉症状，如眩晕、晕厥或复视；然而，非典型的短暂性神经系统表现可能延误诊断。
病例介绍： 一名71岁患者表现为反复言语含糊和左上肢无力，无眩晕或复视。检查发现左臂无可测血压、桡动脉搏动消失、颈动脉杂音以及轻度左上肢远端无力。计算机断层扫描血管造影和数字减影血管造影显示左锁骨下动脉严重狭窄伴侧支循环，符合锁骨下动脉盗血生理。患者成功接受了经皮腔内球囊血管成形术和支架置入术。支架置入后血管造影证实恢复了顺行血流，无残余盗血现象，血运重建后神经和肢体症状改善。
结论： 本病例强调锁骨下动脉盗血综合征可模拟短暂性脑缺血发作，且可能不出现典型的椎基底动脉症状。仔细的血管检查、早期血管影像学检查和及时的血管内治疗对于防止诊断延误和改善临床结局非常重要。

英文摘要

BACKGROUND: Subclavian steal syndrome is an uncommon vascular disorder caused by stenosis or occlusion of the subclavian artery proximal to the vertebral artery origin. It classically presents with vertebrobasilar symptoms such as vertigo, syncope, or diplopia; however, atypical transient neurological presentations may delay diagnosis.
CASE PRESENTATION: A 71-year-old patient presented with recurrent slurred speech and left upper limb weakness without vertigo or diplopia. Examination revealed absent measurable blood pressure and absent radial pulse in the left arm, carotid bruits, and mild distal left upper limb weakness. Computed tomography angiography and digital subtraction angiography demonstrated severe left subclavian artery stenosis with collateral circulation consistent with subclavian steal physiology. The patient underwent successful percutaneous transluminal balloon angioplasty and stenting. Post-stenting angiography confirmed restored antegrade flow without residual steal phenomenon, and the neurological and limb symptoms improved after revascularization.
CONCLUSIONS: This case emphasizes that subclavian steal syndrome can mimic transient ischemic attack and may present without classic vertebrobasilar symptoms. Careful vascular examination, early vascular imaging, and timely endovascular management are important to prevent diagnostic delay and improve clinical outcomes.