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

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侧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.根据未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)....

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

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 restenosis rate of stent side in the normal group was 34.3% （ 12/35 ）, while that in the lesion group was 56.8% （25/44）. There were significant difference between the two groups （ P 〈 0.05 ）. ③Multivariate logistic regression analysis showed that the severe lesion （ severe stenosis or occlusion） of the contralateral vertebral artery was an independent risk factor for restenosis on the stent side （OR, 3. 261, 95% CI： 1. 174 to 9. 058）. Conclusion When there is severe lesions at the original part of bilateral vertebral artery, the stent side of vertebral artery after stenting may immediately play a compensatory role for the blood flow on the non-stent side, however, this compensatory role is also one of the risk factors for occurring in-stent restenosis.