Relationship of Inter-Arm Systolic Blood Pressure Difference with Subclavian Artery Stenosis and Vertebral Artery Stenosis in Patients Undergoing Carotid Endarterectomy

Abstract Introduction: The aim of this study was to examine the association of inter-arm systolic blood pressure difference (IASBPD) with carotid artery stenosis, subclavian artery stenosis and vertebral artery stenosis in patients who underwent carotid endarterectomy. Methods: A total of 141 patients (29 females, 112 males; mean age 71.2±10.4 years; range 47 to 92 years) who underwent carotid endarterectomy between September 2010 and December 2017 were retrospectively evaluated. We classified patients into four groups according to the IASBPD ˂ 10 mmHg, ≥ 10 mm Hg, ≥ 20 mmHg and ≥ 30 mmHg. The stenosis of both subclavian and vertebral arteries was considered as ≥ 50%. Results: Of the 141 patients, 44 (31.2%) had ≥ 10 mmHg, 29 (20.5%) had ≥ 20 mmHg and 4 (2.8%) had ≥ 30 mmHg of IASBPD. 26 patients (18.4%) were diagnosed with significant subclavian artery stenosis and 18 (69.2%) of them had more than 20 mmHg of IASBPD. Of the 29 patients with IASBPD ≥ 20 mmHg, 19 patients (65.5%) had a significant subclavian artery stenosis. We found a significant correlation between preoperative symptoms and subclavian artery stenosis (P=0.018) and overall perioperative stroke was seen more frequently in patients with subclavian artery stenosis (P=0.041). A significant positive correlation was observed between vertebral artery stenosis and subclavian artery stenosis (P=0.01). Conclusion: Patients who were diagnosed with both subclavian artery stenosis and IASBPD (≥ 20 mmHg) had a higher risk of postoperative stroke and death, had higher total cholesterol, LDL-C, blood creatinine level, and were more symptomatic.

摘要 引言：本研究旨在探讨接受颈动脉内膜切除术（carotid endarterectomy）的患者中，臂间收缩压差（inter-arm systolic blood pressure difference, IASBPD）与颈动脉狭窄、锁骨下动脉狭窄及椎动脉狭窄的相关性。方法：回顾性分析2010年9月至2017年12月期间接受颈动脉内膜切除术的141例患者（其中女性29例，男性112例；平均年龄71.2±10.4岁，年龄范围47~92岁）。根据臂间收缩压差水平将患者分为四组：＜10 mmHg组、≥10 mmHg组、≥20 mmHg组及≥30 mmHg组。本研究将锁骨下动脉及椎动脉狭窄程度≥50%定义为重度狭窄。结果：141例患者中，44例（31.2%）臂间收缩压差≥10 mmHg，29例（20.5%）≥20 mmHg，4例（2.8%）≥30 mmHg。26例（18.4%）患者被诊断为重度锁骨下动脉狭窄，其中18例（69.2%）的臂间收缩压差≥20 mmHg。在29例臂间收缩压差≥20 mmHg的患者中，19例（65.5%）存在重度锁骨下动脉狭窄。本研究发现术前症状与锁骨下动脉狭窄存在显著相关性（P=0.018），且合并锁骨下动脉狭窄的患者围手术期脑卒中发生率更高（P=0.041）。椎动脉狭窄与锁骨下动脉狭窄呈显著正相关（P=0.01）。结论：同时确诊锁骨下动脉狭窄且臂间收缩压差≥20 mmHg的患者，术后脑卒中及死亡风险更高，总胆固醇、低密度脂蛋白胆固醇（LDL-C）、血肌酐水平更高，且临床症状更显著。