| ?Objective?This study is designed to evaluate the in-stent thrombosis after vertebral artery origin stenting(VAOS) by color Doppler flow imaging(CDFI). To explore the influence of stent parameter(stent site, stent length, vessel diameter, hemodynamic)and the risk factors of cerebral vascular disease on incidence of in-stent thrombosis after vertebral artery stenting.?Methods?1. A total of 100 patients(117 stents)( 80 males, 20 females, average age 67.1 ±8.9),with atherosclerotic stenosis at the vertebral artery origin diagnosed by DSA and treated with stenting from January 2011 to January 2016 were enrolled respectively,seventeen of them were treated with bilateral VAOS.2. The patients after VAOS were examined by GE LOGIQ E9 Ultrasonic Diagnostic Apparatus with line array 9L probe and convex array probe 4L. Conventional ultrasound and CDFI were used to obtain the normal carotid artery parameters and stent parameters(stent site, stent length, vessel diameter, the peak systolic velocity of3-4 cervical segment and in-stent).3. In-stent thrombosis were evaluated in 1,3,6,12 th month and then every six months after VAOS by CDFI.The incidence of in-stent thrombosis was calculated and the relevant factors of in-stent thrombosis after vertebral artery stenting were analyzed by COX regression.?Results?1. The incidence rate of in-stent thrombosis: The in-stent thrombosis were evaluated in 19 cases(16.2%), the cumulative thrombosis rate at 1, 3,6,12 month were 1.7%? 7.1%?10.2% and 14.2% respectively.2. The influence of stent site, stent length and vessel diameter on incidence of in-stent thrombosis after vertebral artery stenting: There was no significant difference in the incidence rate of in-stent thrombosis among the different length stent groups(P>0.05).There was statistical difference in the incidence rate of in-stent thrombosis among different stent site groups(c2=6.837,P<0.05). The incidence of in-stent thrombosis(12.0%) in patients treated with the SS2 stents was significantly lower than that of SS3stents(34.7%). There was statistical difference in the normal patients after VAOS among different stent site groups(P<0.05); there was statistical difference between SS3 and SS1(P<0.05) or SS2(P<0.05). The VAOS patients who with stent diameter /vertebral artery original diameter<1 after procedure the incidence of in-stent thrombosis was higher than those with stent diameter/vertebral artery original diameter=1(P<0.05).3. The influence of the risk factors of cerebral vascular disease and lipid-lowering drugs(statins) on the incidence of in-stent thrombosis after vertebral artery stenting:There were no significant differences in the in-stent thrombosis among the different risk factors of cerebral vascular disease groups such as hypertension, diabetes mellitus,coronary heart disease, smoking(P<0.05). There was statistical difference in the incidence rate of in-stent thrombosis for the patients with hyperlipidemia or not(P<0.05). The VAOS patients who had not took statins after procedure the incidence of in-stent thrombosis was higher than those who had took statins(36.8%vs.14.8%,P<0.05). Among the patients with hyperlipidemia who had took statins after procedure,the incidence of in-stent thrombosis of VAOS was significantly lower than those had not took statins(P<0.05).4. The influence of preoperative homocysteine level on incidence of in-stent thrombosis after vertebral artery stenting: The VAOS patients who had hyperhomocysteinemia were significantly higher than who had not hyperhomocysteinemia.(34.3%vs.11.0%,P<0.05).5. The influence of anatomy of vertebral artery on incidence of in-stent thrombosis after vertebral artery stenting: There was statistical difference in the incidence rate of in-stent thrombosis among different vertebral artery original diameter(P<0.05). The incidence of in-stent thrombosis of VAOS was higher for patients with distortion of vertebral artery origin(P<0.05).6. The result of multiple-factor analysis: Multivariate logistic regression analysis showed that the preoperative high homocysteine level, vertebral artery original diameter<3mm, stent diameter/vertebral artery original diameter<1 were the independent influencing factors for in-stent thrombosis. The lipid-lowering drugs were used regularly after VAOS was the protective factor for in-stent thrombosis.?Conclusions?1. CDFI is an effective and noninvasive examination to follow-up VAOS and detects in-stent thrombosis immediately.2. The incidence of in-stent thrombosis at 3rd month after VAOS is the highest.3. Hyperhomocysteinemia, improper site of the stent, stent diameter / vertebral artery original diameter<1, vertebral artery original diameter<3mm and distortion of vertebral artery origin are the risk factors for in-stent thrombosis after VAOS.4. Using lipid-lowering drugs regularly after VAOS may effectively decrease the incidence of in-stent thrombosis.5. The high preoperative homocysteine level,vertebral artery original diameter<3mm and stent diameter/vertebral artery original diameter<1 are the independent risk factors for in-stent thrombosis.It is necessary to have a study on the larger sample size to demonstrate some conclusion of our research because of the small number of each group. |
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