| Part Ⅰ Morphological Characteristics of V1 segment of Vertebral arteryObjective To investigate the morphological and anatomical data of V1 segment of vertebral artery in normal adults;To investigate the correlation between the morphological data of V1 segment of vertebral artery and the gender and age and provide help for the diagnosis,interventional therapy,and development of new instrument for the diseases of vertebral artery V1 segment.Materials and Methods 600 cases(365 male,235 female)with computed tomography angiography(CTA)of intracranial and cervical arteries are collected,which were from the patients of the First Affiliated Hospital of Zhengzhou University from January 2013 to December 2015.The scanning range of all the patients was covered by the aortic arch and the whole head and cervical arteries,and the gender and age of the patients were recorded.All the images were transfered to GE post-processing workstation,all raw datas of CT scan were reconstructed for continuous thin slice images with the thickness of 0.625 mm.Through the CT Multiple Planar Reconstruction(MPR),the Curve Planar Reconstruction(CPR)and the three-dimensional reconstruction technique,record and measure V1 segment of vertebral artery origin,diameter,length,the subclavian artery proximal and distal segment diameter,the starting position of quadrant,the included angle with subclavian arteries,shape and position into the transverse foramen.The t test was used to compare the physiological value of V1 segment of vertebral artery between different sexes and different ages;We chose 120 cases of cerebral angiography examination,analysis of the relationship between V1 segment of vertebral artery opening quadrant with DSA optimal projection angle.Using chi square test to compare the differences of different quadrant and the different shape of V1 segment of vertebral artery;.Pairwise comparison among groups was done with LSD method;P < 0.05 has statistical significance.The protocol was approved by the Committee on the Ethics of the First Affiliated Hospital of Zhengzhou University.Results 1.Origin and quadrant of the V1 segment of the vertebral artery:(1)V1segment of the left vertebral artery originated from the left subclavian artery,The percentage of left vertebral artery originating from the aortic arch is 6.8%(41/600);V1 segment of the right vertebral artery originated from the right subclavian artery,and the proportion of abnormal origin of right vertebral artery is 0.67%(4/600),2cases originated from the brachiocephalic bifurcation,2 cases of right carotid artery.The abnormal origin of the left vertebral artery was significantly more than that on the right.(2)The V1 segment of the left vertebral artery originated from the anterior medial quadrant and internal quadrants,with a ratio of 69.2%(415/600)and 18.7%(112/600),respectively.The ratio of in the anterior quadrant was 6.8%(41/600);The V1 segment of the right vertebral artery originated from the anterior medial quadrant and internal quadrants,with a ratio of 72.0%(432/600)and 21.0%(126/600), respectively.The ratio of in the anterior quadrant was 6.8%(41/600),the ratio of in the posterior inner quadrant was 6.8%(41/600).The best projection angles of different quadrants are different.2.Diameter and length of V1 segment of vertebral artery:(1)The diameter of V1 segment of the left vertebral artery is 4.12 ± 0.69 mm,of which the diameter of the male is 4.16 ± 0.67 mm,the diameter of the female is 4.06 ± 0.71 mm,and the diameter was different.Different age groups of people with different diameters;The diameter of the V1 segment of the right vertebral artery is 4.06 ± 1.77 mm,of which the diameter of the male is 4.12 ± 2.19 mm,and the diameter of the female is 3.97 ±0.68 mm.There is no difference in the diameter of the population in different age groups.The average diameter of V1 segment of vertebral artery of male is slightly larger than that of female,but the difference is not statistically significant.(2)The left vertebral artery V1 segment length is 37.19 ± 15.32 mm,of which the male length is38.07 ± 15.06 mm,the female length is 35.82 ± 15.65 mm,there is no significant difference in the length of the different genders;The right vertebral artery V1 segment length is 34.79 ± 10.71 mm,of which the male length is 36.18 ± 10.70 mm,the length of the female is 32.64 ± 10.38 mm,there is significant difference in the length of the different genders.The younger age groups(< 40 years)of the V1 segment of vertebral artery is greater than the length of the elderly(over 40 years).(3)< 40 years old group’s left vertebral artery V1 segment length was 42.69 ± 18.74 mm,the right vertebral artery V1 segment length was 36.62 ± 11.80mm;> 40 years old group’s left vertebral artery V1 segment length was 34.43 ± 12.42 mm,the right vertebral artery V1 segment length was 33.88 ± 10.01mm;The younger age group(<40 years)of the V1 segment of vertebral artery was greater than the length of the elderly(> 40 years).3.The included angle between the V1 segment of vertebral artery and subclavian artery and morphology of V1 segment of vertebral artery:(1)The included angle between the left vertebral artery V1 segment and subclavian artery is(67.12 + 26.58)°,and the included angle of the male is(69.05 + 25.80)°,and the included angle of the female is(64.11 + 27.53)°;The included angle between the right vertebral artery V1 segment and subclavian artery is(91.75±366.13)°,and the included angle of the male is(76.24±25.40)°,and the included angle of the female is(115.83±584.11)°,The left angle is smaller than the right angle,and the right angle has a great variability.The included angle is small in the population over 50 years old.(2)Morphology of V1 segment of left vertebral artery: "C" type accounted for 7.83%,"(?) " type accounted for 13.67%,"S" type accounted for 17.17%," (?) " type accounted for13.50%," 丨 " type accounted for 47.83%;Morphology of V1 segment of right vertebral artery: "C" type accounted for 9.67%,"(?) " type accounted for 7.17%,"S" type accounted for 5.67%,"(?)" type accounted for 7.83%,"丨" type accounted for69.67%.People younger than 50 years of age accounted for a higher proportion of "丨" type.4.Position of vertebral artery entering transverse foramen: The ratio of the left vertebral artery through the C6 transverse process is 93.33%,and the ratio of the transverse foramen of C5 is 5.17%,the ratio of the transverse foramen of C4 is 1.17%,the ratio of the transverse foramen of C7 and C3 is 0.17%;The ratio of the right vertebral artery through the C6 transverse process is 90.83%,and the ratio of the transverse foramen of C5 is 7.33%,the ratio of the transverse foramen of C4 is 1.50%,the ratio of the transverse foramen of C7 is 0.33%.5.Proximal and distal diameters of the subclavian artery at the beginning of the vertebral artery: Proximal and distal diameters of the subclavian artery at the beginning of the left vertebral artery are 8.67±2.26 mm and 7.58±1.73 mm,respectively;Proximal and distal diameters of the subclavian artery at the beginning of the right vertebral artery are 9.22±1.78 mm and 8.03±1.78 mm,respectively.The right diameter is larger than the left diameter,the diameter of the male is larger than that of the female.Conclusions Three dimensional reconstruction image of V1 segment of vertebral artery is an ideal tool to observe and measure the diameter and shape of V1 segment of vertebral artery;In this study,we found the correlation between the V1 segment of the vertebral artery and the gender and age of the normal adults in the middle area of China;The diameter,length and included angle of V1 segment of vertebral artery are asymmetry,which indicated that it was necessary to select appropriate instrument for individualized treatment.Part Ⅱ Clinical Study on the Effect of Stent Implantation for Treatment of Stenosis of V1 Segment of Vertebral arteryObjective To investigate the efficacy and safety of balloon expandable stent implantation in the treatment of V1 segment stenosis of vertebral artery.To investigate the indications,operative methods,complications and restenosis of V1 segment of vertebral artery in patients with stent implantation.To compare the therapeutic effect of SD Express stent and Apollo stent in the treatment of V1 segment stenosis of vertebral artery.Materials and methods 129 cases(108 male,21female)with V1 segment of vertebral artery stent implantation are collected,which were from the patients of the First Affiliated Hospital of Zhengzhou University from January 2014 to June 2016.Preoperative improvement of biochemical examination and imaging examination of color Doppler ultrasound and CTA,Patients who have surgical indications will undergo stent implantation under the guidance of DSA.Patients with local anesthesia,sedation and ECG monitoring,punctured using Seldinger technique.We used a guide wire and catheter for all cerebral angiography,to clear lesion location,diameter,length,eccentricity,and the existence of the diseased vessels and the adjacent vessels or perforating artery,the posterior communicating artery and the external carotid artery and vertebral artery collateral vessels.Using the north American symptomatic carotid endarterectomy tri(NASCET)as the standard,the stenosis rate was measured.6F guiding catheter was introduced,and the SD Express stent or Apollo stent was implanted under the guidance of 0.014 in micro guide wire.We observe changes in the measurement of stenosis rates and perioperative complications.And we analyzed the clinical data of SD Express stent and Apollo stent in the treatment of vertebral artery V1 segment stenosis.3 days after the operation,TCD and carotid color Doppler ultrasonography were reviewed,in order to evaluate the improvement of posterior circulation.The efficacy,complications and the rate of restenosis in patients with long-term follow-up.Using independent samples t test to compare the differences of the indicators between the two kinds of stents;The influence of different factors on restenosis rate was compared by chi square test;Pairwise comparison among groups was done with LSD method;P < 0.05 has statistical significance.The protocol was approved by the Committee on the Ethics of the First Affiliated Hospital of Zhengzhou University.Results A total of 134 stents were implanted in 129 patients,of which 101 patients were implanted with SD Express stent,33 patients were implanted with Apollo stent,and the technical success rate was 100%.The preoperative stenosis rate was 95% ~50%,the average stenosis rate was(70.65±12.27)%.The mean postoperative residual stenosis rate was(5.13±1.34)%(0%-31.40%).Preoperative and postoperative vascular stenosis rate was statistically significant(P=0.00).TCD and carotid color Doppler ultrasonography showed that the posterior circulation blood flow was improved obviously(P <0.05).The symptoms such as dizziness,walking instability and other symptoms improved significantly in 101 cases,the improvement of symptoms was not obvious in 26 cases,mild symptoms occurred in 2 cases,no severe neurological deterioration and death occurred.The patients were followed up for 3 to65 months,23 cases were complicated with restenosis,6 cases were in vessel restenosis,17 cases were in stent restenosis.Diabetes、high Hcy,stenosis of the length of more than 10mm、Stent into the subclavian artery is more than 2 mm、no regular medication may be related to vascular restenosis(P<0.05).Conclusions V1 segment of vertebral artery stenosis stenting technique with high success rate and low complication rate,the posterior circulation blood flow was improved obviously,which is a safe and effective treatment method;SD Express stent and Apollo stent in the treatment of vertebral artery V1 segment stenosis have shown good performance;Effective control of blood glucose and Hcy levels after stent implantation,and taking anti platelet drugs according to the doctor’s advice may be an effective method to prevent restenosis. |
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