颈动脉狭窄闭塞性病变后交通支开放与椎动脉起始段狭窄的关系

摘要

Objective To investigate the correlation between patent posterior communicating artery (PCoA) and proximal vertebral artery stenosis in patients with atherosclerotic carotid artery stenosis disease ( ≥70% ). Methods Examine the intracranial artery and carotid artery by using color Doppler flow imaging (CDFI) in 160 patients with carotid arterial stenosis (≥70% ) confirmed by angiography before and after surgical treatment (endarterectomy, carotid artery stent placement). The patients were divided into patients with PCoA flow group and patients without PCoA flow group, with occurrence rate of proximal vertebral artery stenosis compared between the two groups. Results (1) Flow velocity at proximal vertebral artery before operation ( with PCoA flow) in patients with PCoA flow group was significantly improved compared to that after treatment ( without PCoA flow). Peak systolic velocity ( PSV) and end diastolic velocity ( EDV) values of proximal vertebral artery with and without PCoA flow were 100.76 ±74. 84cm/s, 81.54 ±54. 29cm/s (P =0.000). (2) Patients with PCoA flow accounted for 50% (80/ 160) , including 45.6% (73/160) with stenosis of proximal vertebral artery; Patients without PCoA flow accounted for 50% (80/160) , including 28.1% (45/160) with stenosis of proximal vertebral artery (P =0.002). Conclusion Proximal vertebral artery stenosis rate is significantly higher in patients with severe carotid artery stenosis disease with patent PCoA.%目的 探讨颈动脉狭窄闭塞性病变(≥70%)患者后交通支开放与否与椎动脉起始段狭窄的关系.方法 对160例经血管造影证实颈动脉动脉狭窄(≥70%)并行外科治疗(内膜剥脱术、颈动脉支架术)的患者分为后交通支开放组与后交通支未开放组,术前及术后均采用彩色多普勒血流成像(CDFI)检测双侧颈动脉及椎动脉,分别比较两组患者双侧椎动脉起始段狭窄的发生率.结果 后交通支开放组椎动脉起始段局部流速术前(后交通支开放)明显高于术后(后交通支关闭).后交通支关闭前后椎动脉起始段峰值流速(PSV)与舒张末流速(EDV)分别为100.76±74.84cm/s、81.54±54.29 cm/s(P=0.000);后交通支开放患者占50%(80/160),其中椎动脉起始段存在狭窄支数占45.6%(73/160),后交通支未开放患者占50%(80/160),其中椎动脉起始段存在狭窄支数占28.1%(45/160),两者之间存在显著差异(P=0.002).结论 颈动脉狭窄闭塞性病变后交通支开放患者,椎动脉起始段狭窄的发生率显著升高.