关键词: 冠状动脉旁路移植术, 非体外循环, 锁骨下动脉窃血综合征, 血管成形术, 支架, 无创动脉硬化检测

Abstract: Abstract Objective To 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 A total of 612 patients intend to perform coronary artery bypass grafting in Tianjin Thoracic Hospital, and who were with severe stenosis or occlusion with left subclavian artery were screened by non invasive arteriosclerosis before operation. The diagnosis was confirmed by computerized tomography angiography (CTA), then the stenting angioplasty to the left subclavian artery was performed. The off-pump bypass surgery with the left internal thoracic artery（LITA）- left anterior descending artery (LAD) bypass was performed one week after operation. Results The CTA and digital subtraction angiography (DSA) confirmed the results of the left subclavian stenosis according to the non-invasive artery testing. All the 5 patients were performed with the stenting angioplasty to the left subclavian artery successfully, and the residual stenosis rate was <10%. The clinical symptoms were markedly improved after operations in all symptomatic patients, and the systolic pressure difference was <20 mmHg in two upper extremities. 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, and the average time was about 10 months. No posterior circulation, upper limbs or myocardial ischemia occurred, and the systolic pressure difference was <20 mmHg in two upper extremities. Conclusion The non-invasion testing is of unique value in the screening of the left subclavian artery stenosis.

Key words: coronary artery bypass, off-pump, subclavian steal syndrome, angioplasty, stents, non-invasive arterial sclerosis testing