经颅多普勒超声评估药物涂层球囊预扩联合支架置入治疗椎动脉狭窄的效果及对血流动力学的影响

Application of transcranial Doppler ultrasound to evaluate the effect of drug-coated balloon pre-dilation combined with stent placement in the treatment of vertebral artery stenosis and its influence on hemodynamics.

目的分析药物涂层球囊预扩联合支架置入治疗椎动脉狭窄的效果,并使用经颅多普勒超声评估其对血流动力学的影响。方法前瞻性选择2020年1月至2021年6月到沧州市人民医院就诊的椎动脉狭窄患者96例作为研究对象,依随机信封法分为对照组与研究组,每组各48例。对照组给予普通球囊扩张+支架置入,研究组给予药物涂层球囊扩张+支架置入。比较两组治疗前及治疗后3 d的血流动力学指标,并进行血管再狭窄判断。结果治疗后3 d,两组患者椎动脉颅内段舒张末期流速(EDV)、收缩期峰值流速(PSV)较治疗前低,搏动指数(PI)较治疗前高,且研究组椎动脉颅内段EDV、PSV为(47.55±8.74)、(105.24±11.26)cm/s,较对照组[(90.65±9.21)、(149.75±15.03)cm/s]低,PI为0.95±0.30,较对照组(0.83±0.26)高,差异均有统计学意义(P<0.05)。治疗后3 d,两组患者椎动脉颅外段EDV、PSV水平较治疗前高,阻力指数(RI)较治疗前低,且研究组椎动脉颅外段EDV、PSV水平为(25.12±3.43)、(70.90±8.41)cm/s,较对照组[(20.52±3.23)、(60.98±9.12)cm/s]高,RI为0.50±0.13较对照组(0.61±0.16)低,差异均有统计学意义(P<0.05)。研究组患者血管再狭窄率为22.92%,低于对照组(52.08%),差异有统计学意义(P<0.05)。结论药物涂层球囊预扩联合支架置入治疗椎动脉狭窄的临床效果较好,能够明显改善患者EDV、PSV等血流动力学指标,且不易复发。

Objective To analyze the effect of drug-coated balloon pre-expansion combined with stent placement in the treatment of vertebral artery stenosis,and to evaluate its influence on hemodynamics using transcranial Doppler ultrasound.Methods A total of 96 patients with vertebral artery stenosis who came to Cangzhou People's Hospital from January 2020 to June 2021 were prospectively selected as the research object and randomly divided into control group and study group,with 48 cases in each group.The control group was given ordinary balloon expansion+stent placement,and the study group was given drug-coated balloon expansion+stent placement.The hemodynamic indexes of the two groups before treatment and 3 days after treatment were compared,and vascular restenosis was judged.Results At 3 days after treatment,the end-diastolic velocity(EDV)and peak systolic velocity(PSV)of the intracranial vertebral artery in the two groups were lower than those before treatment,the pulsatility index(PI)was higher than before treatment,and the EDV and PSV of intracranial segment of vertebral artery in the study group were(47.55±8.74),(105.24±11.26)cm/s,which were lower than those in the control group[(90.65±9.21),(149.75±15.03)cm/s],and the level of PI in the study group was 0.95±0.30,which was higher than that in the control group(0.83±0.26),the differences were statistically significant(P<0.05).At 3 days after treatment,the levels of EDV and PSV of the extracranial vertebral artery in the two groups were higher than those before treatment,the resistance index(RI)was lower than before treatment,and the levels of EDV and PSV of the extracranial vertebral artery in the study group were(25.12±3.43),(70.90±8.41)cm/s,which were higher than those in the control group[(20.52±3.23),(60.98±9.12)cm/s],and the level of RI in study group was 0.50±0.13,which was lower than that in the control group(0.61±0.16),the differences were statistically significant(P<0.05).The vascular restenosis rate in the study group was 22.92%,which was lower than that in the control group(52.08%),the difference was statistically significant(P<0.05).Conclusion The clinical effect of drug-coated balloon pre-expansion combined with stent placement in the treatment of vertebral artery stenosis is good,it can significantly improve the hemodynamic indexes such as EDV and PSV,and is not easy to relapse.