椎动脉闭塞患者椎动脉结构特点及闭塞位置对后循环缺血的影响

Characteristics of the vertebral artery and effects of occlusion position on posterior circulation ischemia

目的通过彩色多普勒超声(color doppler f low imaging,CDFI)与经颅彩色多普勒超声(transcranial colorcoded sonography,TCCS)联合检测椎动脉闭塞患者椎动脉结构特点及闭塞位置,并探讨其与后循环缺血是否有相关性。方法回顾性纳入2017年9月—2021年6月经血管超声、CT血管成像/数字减影血管造影证实的椎动脉闭塞住院患者142例,同时选择同一时段经上述影像检查证实无椎动脉闭塞住院患者124例。采用彩色多普勒超声与经颅彩色多普勒超声检查双侧椎动脉颅外段管腔内径和颅内、外段血流动力学情况(包括峰值流速、舒张期末流速及阻力指数),比较椎动脉发育不良对椎动脉闭塞的影响。在证实椎动脉闭塞患者中依据核磁共振扩散加权成像结果分为后循环缺血组和无后循环缺血组,探讨椎动脉闭塞位置与后循环缺血的相关性。结果椎动脉闭塞组中椎动脉发育不良者104例,占73.2%;而无椎动脉闭塞椎动脉发育不良者占24.2%,2组差异有明显统计学意义(χ2=66.556,P<0.001)。后循环缺血组86例椎动脉闭塞患者中椎动脉颅内段闭塞者34例,占39.5%;无后循环缺血组56例椎动脉闭塞患者中椎动脉颅内段闭塞者5例,占8.9%,差异有明显统计学意义(χ2=17.818,P<0.001)。结论CDFI联合TCCS检测可有效评估椎动脉闭塞的部位,并为评估预后提供可靠依据。

Objective To detect the structural characteristics and occlusion locations of the vertebral artery in patients with vertebral artery occlusion,and to find out about the correlations with posterior circulation ischemia.Methods A total of 142 hospitalized patients with vertebral artery occlusion confirmed by vascular ultrasound,CT angiography(CTA),or digital subtraction angiography(DSA)between September 2017 and June 2021 were retrospectively enrolled.Another 124 hospitalized patients without vertebral artery occlusion conf irmed by the above imaging examinations during the same period were selected.CDFI and TCCS were used to examine the internal diameter of the extracranial segment of the bilateral vertebral artery and the hemodynamics of intracranial and extracranial segments(including peak velocity,end diastolic velocity and resistance indexes).The effect of vertebral artery dysplasia on vertebral artery occlusion was studied.Patients with vertebral artery occlusion were divided into the posterior circulation ischemia group and non-posterior circulation ischemia group according to the results of magnetic resonance diffusion weighted imaging(DWI),and the correlation between the occlusion location of the vertebral artery and posterior circulation ischemia was explored.Results There were 104 cases of vertebral artery dysplasia in the vertebral artery occlusion group,accounting for 73.2%.The incidence of vertebral artery dysplasia in patients without vertebral artery occlusion was 24.2%.There was significant difference between the two groups(χ2=66.556,P<0.001).Among the 86 patients with vertebral artery occlusion in the posterior circulation ischemia group,34(39.5%)had intracranial vertebral artery occlusion.There were 5 cases(8.9%)of intracranial vertebral artery occlusion in the 56 cases of vertebral artery occlusion without posterior circulation ischemia.There was significant difference between the two groups(χ2=17.818,P<0.001).Conclusion CDFI combined with TCCS detection can effectively evaluate the location of vertebral artery occlusion and provide reliable data for evaluation of prognosis.