| Objective Discuss the meanings and methods of the screening,diagnosis and treatment of the left subclavian artery stenosis before the coronary artery bypass grafting(CABG).Methods According to the results of the non-invasive artery testing to 612 patients before CABG from January 2014 to January 2016,a total of 5 patients with coronary artery disease accompanying severe subclavian artery stenosis or occlusion were included.These 5 patients were confirmed with CTA.We performed the stenting angioplasty to the left subclavian artery,and then the off-pump bypass surgery with the left internal thoracic artery(LITA)-left anterior descending artery(LAD)bypass a week to 2 weeks later.Results The CTA and DSA confirmed the results of the left subclavian stenosis according to the non-invasive artery testing.All the 5 patients were performed with the the stenting angioplasty to the left subclavian artery successfully,the residual stenosis rate<10%.The clinical symptoms were markedly improved after operations in all symptomatic patients,and the systolic pressure difference between two upper extremities <20mmHg.The blood flow was enough in LITA during the LITA-LAD bypass.The angina pectoris was improved after the operation.No coronary-subclavian artery steal phenomenon occurred.Neither stroke,myocardial infraction nor death occurred during perioperative period.All the patients were followed up for a time of 6-12 months,the average time was about 10 months.No posterior circulation,upper limbs or myocardial ischemia occurred,the systolic pressure difference between two upper extremities <20mmHg.Conclusion The value of the non-invasion testing to the left subclavian artery was unique,and the results could be confirmed by CTA,MRA or DSA.For the patients of coronary artery disease combined with left subclavian artery stenosis,performing the stenting angioplasty to the left subclavian artery before the LITA-LAD bypass was a safe and effective method. |
PDF Full Text Request