单侧椎动脉闭塞患者的血流动力学变化

目的 通过颈动脉彩色多普勒血流成像和经颅多普勒超声联合检测评价单侧椎动脉闭塞后健侧椎动脉、基底动脉的血流动力学变化与后循环缺血发生的关系.方法 选择经DSA证实的单侧椎动脉闭塞患者96例,根据MRI结果分为后循环缺血患者(有症状组,n=50)和无后循环缺血患者(无症状组,n=46),采用颈动脉彩色多普勒血流成像和经颅多普勒超声联合检查健侧椎动脉颅外段管径、健侧椎动脉颅内段和基底动脉收缩期峰值流速及舒张末期流速. 结果有症状组经DSA证实存在颈深动脉、颈升动脉及颈外动脉分支等吻合支代偿者11例(占22.0%),无症状组存在吻合支代偿者12例(占26.1%),两组间吻合支建立的比率无显著性差异(P>0.05);无症状组健侧椎动脉管径(3.54±0.47 mm)明显大于有症状组(3.25±0.45 mm,P<0.01);无症状组健侧椎动脉颅内段收缩期峰值流速和舒张末期流速明显高于有症状组 (87.09±35.47 cm/s和35.85±18.03 cm/s比70.60±31.04 cm/s和27.32±11.75 cm/s,P<0.05);无症状组基底动脉收缩期峰值流速和舒张末期流速也明显高于有症状组 (89.54±35.56 cm/s和37.35±19.34 cm/s比72.98±25.95 cm/s和29.52±11.56 cm/s,P<0.05). 结论单侧椎动脉闭塞后健侧椎动脉的管径、收缩期峰值流速、舒张末期流速与基底动脉的收缩期峰值流速、舒张末期流速血流参数的异常与后循环缺血症状的发生具有密切相关性.

Hemodynamic Changes in Patients with Unilateral Vertebral Artery Occlusion

Aim To investigate role of the morphologic and hemodynamic changes of contralateral vertebral artery(VA) in the occurrence of posterior circulation ischemia(PCI) in patients with unilateral vertebral artery occlusion using color Doppler flow imaging(CDFI) combined with transcranial Doppler(TCD). Methods 96 patients with unilateral vertebral artery occlusion were recruited into this study.Among them,there were 50 cases with PCI and 46 cases without PCI.Diameters of contralateral VA were measured by CDFI.Peak systolic velocity(PSV) and end diastolic velocity(EDV) of contralateral VA and basilar artery(BA) were measured by TCD. Results The presence rate of collateral anastomose on DSA had no differences between two groups(P>0.05).The diameters of contralateral VA in patients without PCI group were 3.54±0.47 mm,which was significantly larger than that in patients with PCI group(3.25±0.45 mm,P><0.01).The PSV and EDV of intracranial segment in contralateral VA in patients without PCI was dramatically higher than VA with PCI(87.09±35.47 cm/s and 35.85±18.03 cm/s vs 70.60±31.04 cm/s and 27.32±11.75 cm/s,P><0.05).The PSV and EDV of BA in patients without PCI group was higher than that with PCI group(89.54±35.56 cm/s and 37.35±19.34 cm/s vs 72.98±25.95 cm/s and 29.52±11.56 cm/s,P><0.05). Conclusion In patients with unilateral VA occlusion,the hemodynamic changes of contralateral VA and BA was strictly related to the occurrence of PCI.