Objective To evaluate the correlations of the site,type and length of stent and the incidence of residual stenosis of vertebral artery origin stenting ( VAOS) with color Doppler flow imaging (CDFI). Methods A total of 177 patients (192 stents) with atherosclerotic stenosis at the vertebral artery origin treated with stenting from January 2009 to September 2011 were enrolled prospectively. They were grouped according to the lengths (L) ,sites (SS) and stent types. The changes of the diameter at the vertebral artery origin, peak systolic velocity ( PSV ) and end diastolic velocity ( EDV) before procedure and 1 week after procedure were compared using CDFI. The incidence of residual stenosis after procedure was evaluated. The incidence of residual stenosis was analyzed in different groups. The digital subtraction angiography ( DSA) images immediately after procedures and the results of CDFI re-examination within 1 week were evaluated. The in-stent residual stenosis ≥ 20% was defined as residual stenosis.rnResults ①According to the results of DSA,84 LI (15mm) stents,51 L2 ( > 15 mm) stents, and 57 L3 ( < 15mm) stents were implanted. There were 45 SSI stents (the whole stent was in the vertebral lumen) , 113 SS2 stents (1/3 of the stent length extended to the proximal end of vertebral artery origin) ,and 34 SS3 stents (1/2 of the stent length extended to the proximal end of vertebral artery origin). There were 66 drug-eluting stents and 126 metal bare stents. ②Within 1 week after stenting,the diameters at the vertebral artery origin were significantly enlarged than those before stenting (2.7 ±0.6 mm vs. 1.1 ±0.3 mm). PSV and EDV improved significantly compared to before procedure,they were 317 + 109 cm/s vs. 123 ±49cm/s and 102 ±54 cm/s vs. 33 ± 15 cm/s respectively. ③The detection rate of residual stenosis after procedure was 22.4% (43/192). There were no significant differences in the incidences of residual stenosis among the durg-eluting stents ( 18. 2% ) , metal bare stents (24. 6% ) and the different length stent groups (P > 0. 05 ). The incidence of residual stenosis (15. 9% ) in patients treated with the SS2 stents was significantly lower than that of SSI stents (31.1%) and SS3 stents (32.4%). Conclusion Stenting may improve the stenotic lumen and hemodynamics. The site of stent is an independent risk factor for residual stenosis after procedure.%目的 通过彩色多普勒血流显像(CDFI)检测评估椎动脉起始段置入支架的位置、类型、长度与残余狭窄发生率的相关性.方法 前瞻性纳入2009年1月-2011年9月因椎动脉起始段粥样硬化性狭窄行支架置入术的患者,共177例(192枚支架).根据支架的长度(L)、位置(SS)及类型分组,采用CDFI检查,比较术前与术后1周内椎动脉起始段的管径、收缩期峰值流速(PSV)、舒张期末流速(EDV)的变化,评价术后残余狭窄的发生率.分析不同分组内残余狭窄发生率的差异性.以术后即刻DSA影像及1周内CDFI复诊结果进行评估,支架内残余狭窄率≥20%定义为残余狭窄.结果 ①根据DSA结果,置入支架的长度L1型(15 mm)84枚、L2型(＞15 mm)51枚、L3型(＜15 mm)57枚;支架位置SS1型(支架全部位于椎动脉管腔内)45枚、SS2型(支架的1/3延伸至椎动脉起始部近心端)113枚、SS3型(支架的1/2延伸至椎动脉起始部近心端)34枚;药物涂层支架66枚及金属裸支架126枚.②支架置入术后1周内,椎动脉起始段的管径较术前明显增大[(2.7±0.6) mm 对(1.1±0.3)mm],PSV和EDV较术前明显改善,分别由(317±109)cm/s降至(123±49) cm/s及由(102±54)cm/s降至(33±15) cm/s,差异有统计学意义(均P＜0.01).③术后残余狭窄的检出率为22.4%(43/192).药物涂层(18.2%)与金属裸支架(24.6%)、支架不同长度组间残余狭窄的发生率,差异均无统计学意义(P＞0.05).支架位置为SS2型残余狭窄的发生率(15.9%)明显低于SS1型(31.1%)和SS3型(32.4%),差异有统计学意义(P＜0.05).结论 支架置入术可改善血管狭窄的管腔及血流动力学,置入支架的位置不当是造成术后残余狭窄的独立危险因素.
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