彩色多普勒超声对椎动脉起始段狭窄支架置入疗效的评价

The evaluation of therapeutic effect of stenting on vertebral artery origin stenosis with color Doppler ultrasound

目的应用彩色多普勒血流显像（color Doppler flow imaging，CDFI）评估椎动脉起始段狭窄性病变患者支架置入前、后的血管内径及血流动力学变化。方法采用CDFI检测39例患者78支椎动脉，其中对椎动脉起始段狭窄（狭窄率≥50％）患者置入支架41枚。记录支架置入前、后血管内径、收缩期峰值血流速度（PSV）、椎动脉起始段与椎间隙段血管搏动指数（PI）等参数，综合评估椎动脉起始段的狭窄率，并对支架置入后再狭窄的可能危险因素（年龄、高血压、冠心病、糖尿病、高脂血症及吸烟）进行Logistic回归分析。随访时间（11±8）个月。结果支架置入术前、后椎动脉起始段内径分别为（1．3±0．4）mm和（2．7±0．7）mm（P=0．000），狭窄率从（64±9）％降至（23±17）％（P=0．000），术前PSV异常高流速（242±102）cm／s，术后降至（87±45）cm／s（P=0．000）。术前患侧椎动脉椎间隙段的PI值为0．77±0．19，健侧为0．96±0．17（P=0．011），术后患侧与健侧椎间隙段比较，PI值差异无显著性（P=0．494）。随访期间支架内再狭窄发生率占29．3％（12／41），表现为PSV等于或高于术前水平。高脂血症患者支架术后再狭窄多发，OR=5．7，95％CI：1．3～25．9（P=0．024）。结论CDFI可作为客观评估椎动脉起始段狭窄和支架置入前、后血流动力学改变，以及远期随访的重要手段。高脂血症可能是引起椎动脉支架置入术后再狭窄的重要危险因素。

Objective To evaluate the changes of inner diameters and hemodynamics in patients with vertebral artery origin stenosis before and after stenting with color Doppler flow imaging （CDFI）. Methods Seventy-eight vertebral arteries in 39 patients were detected with CDFI, among them 41 stents were placed in patients with vertebral artery origin stenosis （ ≥50% ）. The parameters including the inner diameter of vertebral artery and its original part before and after stenting, the peak systolic velocity （PSV） and the pulsatile index （PI） at vertebral artery origin and intervertebral segments were documented. The rate of stenosis at vertebral artery origin was evaluated synthetically, and the possible risk factors （ age, hypertention, coronary artery disease, diabetes, hyperlipemia, and smoking） that might result in restenosis were conducted with logistic regression analysis. The mean follow-up time was 11 ± 8 months. Results The internal diameters of vertebral artery origin before and after stenting were 1.3 ± 0. 4 mm and 2. 7 ±0.7 mm, respectively （P=0.000）. The rate of stenosis decreased from 64 ±9% to 23 ± 17% （P = 0. 000）. The abnormal high flow rate of PVS decreased from 242 ± 102 cm/s before the stenting to 87 ±45 cm/s after the stenting （P =0. 000）. The PI （0. 77 ±0. 19） at the affected sides of vertebral artery origin before the stenting were significantly lower than the unaffected sides （0. 96 ±0. 17, P =0. 011 ） ; and in comparison with the both sides, there were no significant difference between them in PI after the stenting （ P =0. 494）. The incidence of restenosis in the stents was 29. 3% （ 12/41 ） during the follow-up period. It showed that the levels of PSV were equal or higher than those before stenting. Restenosis were common in patients with hyperlipemia after stenting （OR =5.7, 95% CI, 1.2 to 25.9）, R = 1.740 （P =0.024）. Conclusion CDFI may be used as an important means for objective evaluation of the vertebral artery origin stenosis and the changes of hemodynamics before and after stenting and for long-term follow-up study. Hyperlipemia may be an important risk factor for restenosis after vertebral artery stenting.