vertebrobasilar steal syndrome
Introduction
Introduction to vertebral-basal artery stealing syndrome Vertebral-basal artery stealing syndrome refers to when the vertebral-basal artery is obviously narrowed or occluded, it can cause the internal carotid artery to flow through the posterior communicating artery, such as the vertebral basilar artery to compensate, and the internal carotid artery ischemic manifestation, such as Hemiplegia, partial sensory disturbances and aphasia. This syndrome is rare. The disease is more male, with multiple on the left side. The vertebral-basal artery is obviously narrowed or occluded. It is a subclavian artery or an innominate artery that is significantly narrowed or occluded at the proximal end of the vertebral artery. Siphoning causes the ipsilateral vertebral blood flow to flow backward into the subclavian artery, and also makes the contralateral vertebral artery blood. The flow is partially stolen to supply the affected limb, resulting in symptoms of vertebrobasilar insufficiency. The treatment of this disease may be based on the specific circumstances of the choice of endarterectomy, vascular bypass (bridge) surgery, intracranial extracranial anastomosis, etc., to improve the condition of insufficient blood supply. This disease is contraindicated with vasodilators and antihypertensive drugs, which often lead to aggravation of "stealing blood". In addition, it can be combined with symptomatic treatment. basic knowledge Proportion of the disease: the incidence rate in male patients is 0.02%-0.04% Susceptible people: no specific population Mode of infection: non-infectious Complications: hemiplegia aphasia
Cause
Cause of vertebral-basal artery stealing syndrome
The vertebral-basal artery is obviously narrowed or occluded. It is a subclavian artery or an innominate artery that is significantly narrowed or occluded at the proximal end of the vertebral artery. Siphoning causes the ipsilateral vertebral blood flow to flow backward into the subclavian artery, and also makes the contralateral vertebral artery blood. The flow is partially stolen to supply the affected limb, resulting in symptoms of vertebrobasilar insufficiency.
Prevention
Vertebral-basal artery stealing syndrome prevention
The treatment of this disease may be based on the specific circumstances of the choice of endarterectomy, vascular bypass (bridge) surgery, intracranial extracranial anastomosis, etc., to improve the condition of insufficient blood supply. This disease is contraindicated with vasodilators and antihypertensive drugs, which often lead to aggravation of "stealing blood". In addition, it can be combined with symptomatic treatment. How to prevent subclavian steal syndrome? Early detection, early diagnosis and early treatment are the key.
Complication
Vertebral-basal artery steal syndrome Complications hemiplegia aphasia
Hemiplegia, aphasia and other manifestations of internal carotid artery ischemia.
Symptom
Symptoms of vertebral-basal artery stealing syndrome Common symptoms of diplopia visual acuity hazy blurry dysarthria intermittent dizziness ataxia hemianopia partial sensation disorder syncope
Usually, the upper limbs of the affected side have episodes of dizziness, blurred vision, diplopia, ataxia, dysarthria, and syncope. The blood circulation of the posterior circulation (brain stem, occipital lobe, and cerebellum) is severe. The posterior communicating artery is countercurrent, leading to ischemic symptoms of the internal carotid artery system such as hemiplegia, partial sensory disturbance and aphasia.
Examine
Examination of vertebral-basal artery steal syndrome
Clinical manifestations of recurrent internal carotid artery system TIA, such as lesion side-pass black sputum, contralateral reversible hemiparesis, limb numbness and aphasia; internal carotid artery pulsation weakened or disappeared, and can hear vascular murmur. Routine examination of blood and CSF is generally non-specific.
1. Transcranial Doppler ultrasound (TCD) detection of cervical vascular and blood flow suspects should be tested on the affected side of the beam, can detect changes in the reverse blood flow of the vertebral artery.
2. Digital subtraction angiography (DSA) focuses on the observation of vessels such as the subclavian artery and common carotid artery on both sides of the aortic arch. If the subclavian or brachiocephalic trunk is found to be dry, the proximal segment of the vertebral artery is severely stenotic (mostly 85% of the lumen) or almost occluded, and even the contrast agent is seen to rise up to the basilar artery through the contralateral vertebral artery. The descending (reverse flow) to the distal end of the affected subclavian artery is more likely to be diagnosed.
Diagnosis
Diagnosis and differentiation of vertebral-basal artery stealing syndrome
diagnosis
Check the limb weakness, paresthesia, pale skin and muscle pain, the affected side of the pulse is weakened, the upper arm blood pressure of the affected side is lower than the healthy side 20mmHg, the supraclavicular fossa can smell the noise; if the active limb induces or aggravates the vertebral-basal artery blood supply Insufficient symptoms are helpful for diagnosis and DSA can be diagnosed.
Differential diagnosis
It is differentiated from cerebrovascular disease, cerebral arteriosclerosis, and intracranial venous sinus thrombosis.
