目的探讨以脑缺血为主要症状的主动脉弓上血管狭窄性病变的介入治疗效果。方法52例患者的共56处主动脉弓上狭窄性病变接受了血管腔内治疗,其中锁骨下动脉狭窄22处,锁骨下动脉闭塞14处,颈内动脉狭窄12处,无名动脉狭窄8处。病变的狭窄程度均大于60%(65%~100%)。所有患者均表现出脑缺血的症状,如头痛、头晕、发作性肢体无力、黑朦等,其中部分患者锁骨下动脉和无名动脉病变的病例还同时伴有上肢缺血症状。56处病变中,单纯行血管扩张术15例、放置支架39例,有2例锁骨下动脉闭塞的病例因闭塞段坚硬无法打通而改行外科手术治疗。4例颈内动脉狭窄的病例在支架放置过程中使用了保护伞装置。11例锁骨下动脉闭塞病变由于顺行打通比较困难,采用经股动脉和肱动脉联合入路进行治疗。结果手术技术成功率为96·4%(54/56),成型后血管残余狭窄均小于30%。所有患者的临床症状均明显改善。发生手术相关并发症3例,占所有接受治疗患者的5·8%(3/52),无死亡病例。随访46例,随访率88%,平均随访时间24个月,无死亡及严重脑卒中发生。有2例只接受经皮血管腔内成型术治疗的患者发生术后再狭窄。结论对于以脑缺血为主要症状的主动脉弓上血管狭窄性病变,血管成型术和/或支架置入术是安全有效的治疗方法。 Objective To investigate the interventional treatment of upper stenosis of aortic arch with cerebral ischemia as the main symptom. Methods Totally 56 aortic arch stenosis lesions were treated by endovascular treatment in 52 patients. Among them, 22 were subclavian artery stenosis, 14 were subclavian artery occlusion, 12 were internal carotid artery stenosis, and 8 were unnamed artery stenosis. Stenosis were more than 60% (65% to 100%). All patients showed symptoms of cerebral ischemia, such as headache, dizziness, episodes of limb weakness, darkness, etc. Some of the patients with subclavian artery and anonymous arterial lesions also accompanied by symptoms of upper limb ischemia. Of the 56 lesions, 15 cases were simply dilation of blood vessels and 39 cases were placed in stents. Two cases of occlusion of subclavian artery were unable to get through the occlusion and were switched to surgical treatment. In 4 cases of carotid artery stenosis, an umbrella device was used during stent placement. Eleven cases of subclavian artery occlusion due to straight through the more difficult to get through the femoral artery and brachial approach for treatment. Results The success rate of surgical technique was 96.4% (54/56). Residual vascular stenosis was less than 30%. Clinical symptoms were significantly improved in all patients. Three cases of surgery-related complications occurred, accounting for 5.8% (3/52) of all patients treated, with no deaths. Follow-up 46 cases, follow-up rate of 88%, the average follow-up time of 24 months, no deaths and severe stroke. Two patients underwent restenosis with percutaneous transluminal angioplasty only. Conclusions Angioplasty and / or stent placement is a safe and effective treatment for stenosis of the aortic arch, which is characterized by cerebral ischemia.