| Objective:To investigate the feasibility of color coding of digital subtraction angiography(CQ-DSA)in assessing the hemodynamic changes before and after carotid artery stenting(CAS)and vertebral artery stenting(VAS)and explore the correlation between CQ-DSA and color Doppler ultrasound.Methods:From December 2016 to September 2018,16 patients with internal carotid artery stenosis and 13 patients with vertebral artery stenosis who received endovascular interventional therapy in our hospital were retrospectively analyzed.The angiographic images before and after stent implantation were derived from the workstation and processed by CQ-DSA to obtain color coded images.Setting points of interest(POI):1)POI was set in common carotid artery,C1 segment of internal carotid artery,M1 segment of middle cerebral artery and transverse sinus on the affected side in CAS patients;2)POI was set in V2,V4 segment of vertebral artery and basilar artery on the affected side in VAS patients.The peak time of hemodynamic parameters(C-TTP,V-TTP)was obtained from the color-coded images of CAS and VAS.Common carotid artery and the V2 segment of vertebral artery were set as reference points,and the relative peak time(C-rTTP,V-rTTP)of CAS and other POIs of VAS were calculated.Hemodynamic parameters of color Doppler ultrasonography before and after carotid and vertebral artery surgery were collected:1)The peak systolic velocity(C-PSV)and end diastolic velocity(C-EDV)of the stenosis segment of the carotid artery and the normal lumen of the C1 segment of the internal carotid artery were collected from CAS patients;2)The peak systolic velocity(V-PSV)and end diastolic velocity(V-EDV)were collected from the stenosis segment of vertebral artery and the normal lumen of V2 segment of vertebral artery in VAS patients.The correlations between CQ-DSA and color Doppler ultrasonography were explored.Results:16 patients with internal carotid artery stenosis and 13 patients with vertebral artery stenosis successfully completed stenting.No serious adverse events occurred during perioperative period.1)CAS:The relative peak time of C1 segment of internal carotid artery and Ml segment of middle cerebral artery(C-rTTPl,C-rTTP2)after operation was lower than that before operation,the difference was statistically significant(1.53± 1.43 VS 0.15±0.41,P<0.05;2.26±1.24 VS 0.82±0.67,P<0.05),and the relative peak time of the ipsilateral transverse sinus(C-rTTP3)after operation was also lower than that before operation(11.12±5.76 VS 8.63±1.53),but the difference was not significant.The peak systolic velocity(C-PSA1)and end diastolic velocity(C-EDV1)of the stenosis segment were significantly lower than those before operation(414.4±153.4 VS 126.4±72.08,P<0.05;180.9±122.8 VS 44.44±28.97,P<0.05),and the peak systolic velocity(C-PSA2)of the distal stenosis significantly higher than that before operation(80.93±28.65 VS 118.6±36.12,P<0.05),while end diastolic velocity(C-EDV2)was higher than that before operation,there was no significant difference(37.38±17.03 VS 45.02±15.37,P>0.05).Both methods suggested that the carotid artery hemodynamics improved after CAS,and Pearson correlation analysis indicated that there was weak correlation between the two methods in changes of hemodynamic parameters before and after CAS.2)VAS:The relative peak time(V-rTTP1,V-rTTP2)of V4 segment of vertebral artery and basilar artery of affected side after operation was significantly lower than that before operation(1.76±0.47 VS 0.92±0.70,P<0.05;2.25±0.71 VS 1.36±0.77,P<0.05).The peak systolic velocity(V-PSA1)and end diastolic velocity(V-EDV1)of the stenosis segment were lower than those before operation by color Doppler ultrasonography of vertebral artery after operation,the difference was statistically significant(297.5±97.02 VS 140.2±56.12,P<0.05;90.77±69.83 VS 34.54±16.53,P<0.05).The peak systolic velocity(V-PSA2)and end diastolic velocity(V-EDV2)at the distal end of stenosis were higher than those before operation,and the difference was statistically significant(39.46± 15.27 VS 64.00± 15.17,P<0.05;15.69±4.92 VS 22.15±7.27,P<0.05).Both of them suggested that vertebral artery hemodynamics was improved after VAS.but Pearson correlation analysis indicated that there was no correlation between the two methods in changes of hemodynamic parameters before and after VAS.Conclusion:The CQ-DSA can evaluate the hemodynamic improvement of patients after carotid artery stent implantation and vertebral artery stent implantation without increasing the intake of contrast medium and radiation. |
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