鎖骨下動脈・腕頭動脈に対する経皮的血管形成術中のリアルタイム椎骨動脈エコー

抄録

Subclavian steal phenomenon (SSP) is a well-known atherosclerotic disease. It is due to stenosis/occlusion of the innominate or subclavian artery which is usually treated with percutaneous transluminal angioplasty and stenting. However, the moment of intraoperative flow direction change in vertebral artery is unknown. In this study, we used intraoperative duplex ultrasonography (DUS) of the ipsilateral vertebral artery to detect flow direction change and microembolic signals (MES). Intraoperative DUS were continued on pre-dilatation, stenting and post-dilatation. The technician’s hand was protected from radiation with a special protector. Six patients were included. Four patients underwent left subclavian artery stenting, one patient had right subclavian artery stenting and one patient had innominate artery stenting. In 4 patients, SSP was normalized when balloon-stent was open, and in one patient, SSP was normalized after pre-dilatation. Only one patient had post-dilatation, after that SSP was normalized and MES was observed. It is controversial whether intraoperative vertebral artery protection for subclavian artery stenting is necessary or not. In this study, immediately after deflation of stenting balloon, vertebral artery flow became anterograde. In the case of plaque rupture, there is a possibility of plaque embolization. In addition, one patient showed MES after post-dilatation. This suggests vertebral artery protection might be necessary.