超声评价椎动脉颅外段狭窄闭塞性病变血运重建的成功性

目的探讨彩色多普勒血流成像（CDFI）对椎动脉（VA）颅外段狭窄或闭塞性病变血运重建成功性的评估价值。 方法回顾性纳入2015年9月至2017年12月首都医科大学宣武医院因症状性颅外段VA狭窄或闭塞性病变行单纯VA内膜切除术（VAE）或VAE并支架植入（VAE＋Stent）复合再通术治疗的患者共27例。采用CDFI检测并比较术前、术后VA内径和收缩期峰值流速（PSV）、舒张期末流速（EDV）的差异，分析单纯VAE与VAE＋Sent两种术式再通率的差异。 结果（1）27例患者经CDFI及数字减影血管造影（DSA）确诊为VA起始段重度狭窄者11例（40.7%），闭塞16例（59.3%），其中单纯行VAE患者55.6%（15/27），行VAE＋Stent患者44.4%（12/27）。单纯VAE组VA狭窄患者占60.0%（9/15），VA闭塞患者占40.0%（6/15），而VAE＋Stent组VA狭窄患者占16.7%（2/12），VA闭塞患者占83.3%（10/12），2组差异有统计学意义（χ²=5.185，P=0.023）。（2）27例患者血流重建再通率为96.3%（26/27）。VAE＋Stent组患者再通率为91.7%（11/12），相对高于单纯VAE组患者再通率73.3%（11/15），但差异无统计学意义（χ²=1.485，P=0.223）。VA狭窄组患者再通率为72.7%（8/11），相对低于VA闭塞组患者再通率87.5%（14/16），但差异也无统计学意义（χ²=0.943，P=0.332）。单纯VAE组再通患者VA狭窄者占63.6%（7/11），VA闭塞者占36.4%（4/11），而VAE＋Stent组再通患者VA狭窄者占9.1%（1/11），VA闭塞者占90.9%（10/11），2组差异有统计学意义（χ²=7.071，P=0.008）。（3）VA狭窄组患者术后VA起始段内径较术前增加［（3.2±0.5）mm vs （0.9±0.16）mm］，PSV、EDV均较术前降低［（136±54）cm/s vs （350±91）cm/s，（36±18）cm/s vs （111±44）cm/s］，且差异均有统计学意义（t=13.127，P<0.001；t=6.373，P<0.001；t=4.866，P=0.001）；VA闭塞组患者术后VA起始段内径为（3.5±0.8）mm，PSV为（120±83）cm/s，EDV为（36±29）cm/s，均恢复正常。 结论CDFI可以客观评估单纯VAE或VAE＋Stent对于VA狭窄闭塞性病变血运重建术的成功性，具有重要的临床应用价值。

Evaluation of the successful revascularization in extracranial vertebral artery stenosis or occlusion by color Doppler flow imaging

ObjectiveTo evaluate the value of color doppler flow imaging (CDFI) in successful reconstruction of extracranial vertebral arterial stenosis or occlusion. MethodsA total of 27 patients with symptomatic extracranial vertebral artery stenosis or occlusive disease undergoing vertebral artery endarterectomy (VAE) or VAE and stent implantation (VAE+ Stent) were included in this study from Sep. 2015 to Dec. 2017. The difference of vascular diameter and blood flow velocity (PSV and EDV) before and after surgery for the patients with stenosis or occlusive lesions was compared, and the rate of recanalization between VAE and VAE+ Stent was analyzed. Results(1) 11 cases (40.7%) with severe vertebral artery stenosis (VAS) and 16 cases (59.3%) with vertebral artery occlusion (VAO) were detected by CDFI and confirmed by DSA. Among the 27 patients, VAE accounted for 55.6% (15/27 cases), and VAE+ Stent was 44.4% (12/27). The patients with VA stenosis in VAE group accounted for 60% (9/15), while the patients with VA occlusion in VAE+ Stent group accounted for 83.3% (10/12), the difference is statistically significant (χ²=5.185, P=0.023). (2) The rate of recanalization was 96.3% (26/27) in all of 27 patients. The rate of recanalization in patients with VAE+ Stent (91.7%) was higher than that of VAE (73.3%), but there was no statistically difference (χ²=1.485, P=0.223). The rate of recanalization in patients with VAS (72.7%) was lower than VAO (87.5%), but there was no significant difference (χ²=0.943, P=0.332). The patients with VA stenosis in VAE recanalization group accounted for 63.6% (7/11), while the patients with VA occlusion in VAE+ Stent recanalization group accounted for 90.9% (10/11), the difference was statistically significant (χ²=7.071, P=0.008). (3) The diameter and velocity (PSV vs EDV) in patients with VAS and VAO increased after operation (t=13.127, P=0.000, t=6.373, P=0.000 and t=4.866, P=0.001). ConclusionCDFI could be useful for evaluating the success of VAE or VAE+ Stent.