双侧椎动脉起始段狭窄一侧支架置入后血流动力学的变化及其与再狭窄关系  

Hemodynamics alteration after the vertebral artery stenting in patients with bilateral vertebral artery severe stenosis and its relationship with restenosis

作　　者：贾凌云[1] 华扬[1] 李景植[1] 杨洁[1] 唐旸烁[1] 

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053

出　　处：《中国脑血管病杂志》2011年第11期576-580,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：首都特色临床医学技术发展研究项目(Z090507017709023);国家自然科学基金资助项目(81070924)

摘　　要：目的研究双侧椎动脉起始段狭窄患者未置入支架侧椎动脉起始段病变程度对支架置入则椎动脉血流动力学的影响及其与再狭窄的关系。方法纳入155例经DSA证实的一侧椎动脉起始段重度狭窄(70%～99%)并行支架置入术的患者。根据末置入支架侧椎动脉起始段情况,将患者分为正常组(71例)、重度狭窄组(29例)和闭塞组(55例)。在支架置入术前、术后1周内及1年时,进行颈动脉彩色多普勒超声(CDFI)和经颅多普勒(TCD)检查,记录椎动脉起始段(OS)、椎间隙段(iv)及颅内段(IC)收缩期峰值流速(PSV)和舒张末期流速(EDV)。结果①术后1周内,与正常组比较,重度狭窄组支架侧椎动脉起始段的PSVos、EDVos略有升高,但差异无统计学意义;而闭塞组的PSVos、EDVos明显升高,差异有统计学意义(P<0.05)。重度狭窄组和闭塞组支架侧椎间隙段、颅内段的PSV、EDV均较正常组升高(P<0.05)。闭塞组支架侧的上述参数均较重度狭窄组略有升高,但差异无统计学意义。②术后1年,79例获得超声随访,正常组35例,重度狭窄组15例,闭塞组29例。将重度狭窄组和闭塞组合并分析(狭窄或闭塞组)。狭窄或闭塞组支架侧的PSVos和EDVos均高于正常组;正常组支架侧的再狭窄率为34.3%(12/35),狭窄或闭塞组为56.8%(25/44),两组间差异均有统计学意义(P<0.05)。③多因素Logistic回归分析显示,对侧椎动脉存在重度狭窄或闭塞是支架内再狭窄的独立危险因素(OR=3.261,95%CI:1.174～9.058)。结论当存在双侧椎动脉起始段严重病变时,术后支架置入侧椎动脉可立刻对未置入侧的血流发挥代偿作用。但这种代偿作用同时也是发生支架内再狭窄的危险因素之一。Objective To investigate the effect of contralateral vertebral arterial hemodynamics after unilateral vertebral artery stenting and its relationship with restenosis. Methods A total of 155 patients with severe stenosis（70 -99% ） at the origin of unilateral vertebral artery confirmed by digital subtract angiography （DSA） and underwent stent implantation were recruited in the study. According to the contralat- eral vertebral artery lesions, they were divided into 3 groups ： normal group （ n = 71 ）, severe stenosis group （n = 29） and occlusion group （ n = 55 ）. Carotid color Doppler flow imaging （CDFI） and transcranial Dopper （TCD） were performed before stenting, within 1 week, and 1 year after stenting. Peak systolic velocity （PSV） and end diastolic velocity （EDV） of vertebral arteries at the original part （OS）, intervertebral segment（IV） and intracranial （IC） segments were recorded. Results①Compared to the normal group within 1 week after stenting, the PSVos and EDVos of the original part of the stent side vertebral artery in the severe stenosis group increased slightly, but there were no significant differences; the PSVos and EDVos in the occlusion group increased significantly （ P 〈 0.05 ）. The PSV and EDV of the intervertebral and intraeranial segments at the stent side in the severe stenosis group and the occlusion group were significantly higher than those in the normal group （P 〈 0.05 ）. The above parameters on the stent sides in the occlusion group were slightly higher than those in the severe stenosis group, but the difference was not sta- tistically significant. ②One year after stenting, 79 patients were followed up with uhrasound. There were 35 patients in the normal group, 15 in the severe stenosis group, and 29 in the occlusion group. The severe stenosis group and occlusion group were combined and analyzed （lesion group）. PSVos and EDVos of stent side in the lesion group were significantly higher than those in the normal group ; the

关 键 词：椎动脉狭窄 支架 超声检查 多普勒 血流动力学 再狭窄 

分 类 号：R743[医药卫生—神经病学与精神病学]