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

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).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 an-giography (DSA) and underwent stent implantation were recruited in the study. According to the contralateral 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) , interverte-bral segment(IV) and intracranial (IC) segments were recorded. Results (l)Compared to the normalgroup 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 intracranial 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, hut the difference was not statistically significant. (2)0ne year after stenting, 79 patients were followed up with ultrasound. 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). (3)Multivariate 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.