| [Objective] Vertebral artery is the important blood vessels of t posterior circulation.Now we entering an aging society, vertebral artery stenosis caused by atherosclerotic plaque is also increasing, and the initial segment of the vertebral artery stenosis is more common.In the past20years, with the rapid development of interventional treatment, percutaneous angioplasty has gradually become the main treatment of severe stenosis of the vertebral artery, and now we are urgent need an accurate and convenient screening method to evaluate the effect of percutaneous angioplasty and forward follow-up. Transcranial Doppler (TCD) and vascular color Doppler ultrasound are noninvasive, convenient, reusable and inexpensive, were used in clinical widely. This review is to explore the value of using vascular transcranial Doppler combined with vascular color Doppler ultrasound to detect hemodynamic changes before and after interventional therapy of the narrow initial segment of the vertebral artery.[Method] From January2013to February2014,30patients underwent percutaneous angioplasty who had the internal segment of vertebral artery stenosis were divided into case groups. Transcranial Doppler (TCD) and vascular color Doppler ultrasound were done before and3days after percutaneous angioplasty. And selecting60cases of healthy people as control group who did TCD and vascular color Doppler ultrasound examination.We evaluated the following respects:1. Before the Percutaneous angioplasty, compared with the inner diameter of the initial segment of the vertebral artery, intervertebral segments and intracranial segments of vertebral artery blood flow velocity(PSV), resistance index (RI), pulsatility index (PI),flow direction between the case group and the control group.2. Compared with the inner diameter of the initial segment of the vertebral artery and hemodynamic contrast between the narrow side and the contralateral side, contralateral side and control group.3. DSA as a golden standard, assessment the sensitivity and specificity of TCD, vascular color Doppler ultrasound and TCD combine with vascular color Doppler ultrasound to detect vertebral artery stenosis;4. The inner diameter of case group and the haemodynamics of the initial segment, intervertebral segments and intracranial segments of vertebral artery were compared during before and post operation.[Results]1.There was no significance in age case group and the control group showed no significant difference (P>0.05). Vascular Color Doppler ultrasound shown the inner diameter of the initial segment of the narrow side in the case group (1.71±0.40mm) was significantly smaller than control group(3.77±0.60mm)(P<0.05), while the inner diameter of contralateral vertebral artery (4.10±0.45mm) showed no significant difference compared with the control group (P>0.05). Initial segment of the vertebral artery in the narrow side of the case group,peak systolic blood flow velocity (236.43±60.03cm/s) faster than the control group (68.92±9.36cm/s), resistance index (0.82±0.12) higher than the control group (0.64±0.19); Intervertebral segment of vertebral artery blood flow velocity (44.34±12.15cm/s) slower than the control group (55.18±12.83cm/s), resistance index (0.41±0.10) lower than the control group (0.62±0.15), the differences were statistically significant (P<0.01); Contralateral initial segment and intervertebral segment of vertebral artery blood flow velocity, resistance index, respectively, compared with the control group, the differences were not statistically significant (P>0.05);2. TCD shown intracranial segment of vertebral artery blood flow velocity (31.56±11.65cm/s) slower than the control group (77.47±11.35cm/s), the pulsatility index (0.62±0.23) lower than the control group (0.91±0.18), the differences were statistically significant (P<0.05); While compared with the control group, the intracranial segment of the contralateral vertebral artery, the blood flow velocity and pulsatility index has no significant difference (P>0.05). The PSV and PI of Basilar artery compared with the control group showed no significant difference (P>0.05).3. DSA as the detection standard of initial segment of the narrow vertebral artery, Vascular color Doppler ultrasound detection only, the sensitivity was81.7%, the specificity was92.8%; Pure TCD detection, the sensitivity was83.3%, the specificity was89.7%, vascular color Doppler ultrasound combined with TCD, the sensitivity was91.7%, the specificity was96.2%;4. After stenting:the diameter of narrow the vertebral artery widened to (3.75±0.56mm), compared with the preoperative widened133%, the difference was statistically significant (P<0.01); The blood flow velocity of initial segment decreased to (73.98±12.08cm/s), compared with preoperative slowed down71.9%, resistance index decreased to(0.69±0.18), compared with preoperative reduced17.1%; The blood flow velocity of intervertebral segment compared with preoperative increased31.3%, resistance Index(0.61±0.19) compared with preoperative increased46.1%, the differences were statistically significant (P<0.05); The blood flow velocity of intracranial segment increased to (76.12±15.3cm/s), compared with preoperative increased162.0%, pulsatility index(0.9±0.23) increased54.9%, the differences were statistically significant (P<0.01); While the contralateral artery compared with preoperative, vertebral artery diameter, PSV and PI of vertebral artery showed no significant difference, the blood flow velocity and pulsatility index of basilar artery compared with the preoperative also had no significant difference (P>0.05).[Conclusions] TCD combined with ultrasound to detect hemodynamic changes of the narrow initial segment of the vertebral artery after stenting, the PSV of initial segment of the vertebral artery decreased by71.9%, resistance index decreased by17.1%, and the sensitivity of TCD combined with ultrasonic detection was91.7%,the specificity of96.2%, so TCD combined with color Doppler ultrasound can be used for screening and observing the hemodynamic change of vertebral origin artery stenosis before and after stenting. |
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