| Abstract | Fenomen krađe krvi potključne arterije proizlazi iz okluzije ili stenoze arterije subklavije koje su rezultat ateroskleroze te uzrokuju retrogradni protok krvi u zahvaćenoj vertebralnoj arteriji. Osiguravajući dostatan protok gornjim ekstremitetima, „krade” krv mozgu iz cerebralne cirkulacije. Postoje dvije vrste navedenog sindroma, a to su koronarno-potključni te klasični. Osim ateroskleroze, javljaju se i drugi uzroci poput kongenitalnih anomalija, Takayasu arteritisa te arteritisa velikih stanica. Razlikujemo nepromjenjive i modificirane čimbenike rizika sindroma. Neki od njih su dijabetes, pušenje, hipertenzija, dob te muški spol. Iako je ova bolest iznimno rijetka te su pacijenti koji boluju od nje većinom asimptomatski, neki ipak razviju simptome te je kod njih sindrom otkriven slučajno. Najčešće su simptomi povezani sa ishemijom ruke, dok su drugi uzrok neuoroloških poremećaja. To mogu biti vrtoglavica, hladnoća, utrnulost, klaudikacija, ataksija, diplopija, nistagmus, zamućenje vida, parastezija, gubitak sluha te napadaji epilepsije. Osnovne simptome poput promjene boje kože ruku te noktiju, smanjenje radijalnog pulsa ili njegovo odsustvo, razlike u brahijalnim sistoličkim tlakovima ruku i šumove potključne i vertebralne arterije možemo uočiti fizikalnim pregledom. Pojava novijih tehnika snimanja utječe na poboljšanje uspješnog postavljanja dijagnoze i prevalencije. Prevalencija sindroma krađe krvi arterije subklavije je između 0,6% do 6%. Kod pacijenata, koji su podvrgnuti revaskularizaciji koronarnih arterija, hemodinamski značajna stenoza lijeve potključne arterije prisutna je u oko 2,5%. Istraživanja pokazuju povezanost između pojave simptoma s povećanjem razlike u krvnom tlaku ruku. Sindrom se najčešće dijagnosticira ultrazvučnom, neinvazivnom Doppler tehnikom, dok nam za potvrdu dijagnoze služe CT i MR angiografija. Najvažnije metode koje koristimo u terapiji sindroma su radiološke metode koje obuhvaćaju kompjutoriziranu tomografiju, magnetsku rezonanciju, angiografiju te ultrazvuk. Njihov doprinos u dijagnostici fenomena je uvelike značajan te svaka od njih može biti izbor zbog svojih značajnih prednosti. Najbolja terapija za početak je uvijek konzervativni tretman,a za ozbiljnije slučajeve rezerviramo kirurški pristup. Perkutana transluminalna angioplastika te stentiranje su pouzdane tehnike čiji je cilj liječenja obnavljanje stalnog i normalnog protoka krvi u vertebralnoj arteriji. |
| Abstract (english) | Subclavian steal phenomenon results from occlusion or stenosis of subclass arteries from atherosclerosis and causing retrograde blood flow in the affected vertebral artery. By providing sufficient flow to the upper extremities, it „steals” blood from cerebral circulation. There are two types of this syndrome, which are coronary-subclavian and classical. Except atherosclerosis, we have some other causes such as congenital anomalies, Takayasu’s arteritis and large cell’s arteritis. There is a difference between unchanged and modified risk factors. Some of them are diabetes, smoking, hypertension, age and male sex. Although this disease is extremely rare and patients suffering from it are mostly asymptomatic, there are some people who develop symptoms that are detected by chance. The most common symptoms are associated with ischemia of the arms, while others are the cause of neuorological disorders. These can be dizziness, coldness, numbness, claudication, ataxia, diplopia, nystagmus, blurred vision, paraesthesia, hearing loss and seizures of the epilepsy. Basic symptoms such as changes in skin and nails color, radial pulse decrease or its absence, differences in the brachial systolic pressure of the arms and the noise of the subcutaneous and vertebral arteries can be observed by physical examination. The appearance of newer recording techniques affects the improvement of successful diagnosis and prevalence. The prevalence of th subclavian steal syndrome is between 0.6% and 6%. In patients with coronary artery revascularization, hemodynamically significant left subclavian artery stenosis is present in about 2.5%. Studies show a correlation between the occurrence of symptoms with increased blood pressure difference. The syndrome is most commonly diagnosed by ultrasonic, non-invasive Doppler technique, while CT and MR angiography are used for confirmation of diagnosis. The most important methods used in syndrome therapy are radiological methods that include computerized tomography, magnetic resonance imaging, angiography and ultrasound. Their contribution to the phenomenon's diagnosis is greatly significant and each of them can be a choice because of its significant advantages. We always choose conservative treatment for the beginning, but for serious cases we use surgical approach. Percutaneous transluminal angioplasty and stenting are reliable techniques whose purpose is to renew constant and normal blood flow in the vertebral artery. |
