To Evaluate The Hemodynamic Changes Of Intracranial Stenosis Of Vertebral Artery And The Correlation Of Posterior Circulation Ischemia

This thesis consists of two parts:(1)The feasibility of multi modality imaging based on carotid Doppler ultrasonography evaluating intracranial stenosis of vertebral artery.(2)Investigate the correlation between different stenotic lesions of intracranial vertebral artery and posterior circulation ischemia.Part ?: The feasibility of multi modality imaging based on carotid Doppler ultrasonography evaluating intracranial stenosis of vertebral arteryObjiectiveInvestigate the feasibility of multi modality imaging based on carotid Doppler ultrasonography evaluating intracranial stenosis of vertebral artery.MethedsFrom January 2014 to January 2015 were retrospectively enrolled in neurology department of First Hospital Affiliated to Suzhou University in 159 patients complained of headache and dizziness patients.All subjects underwent CDU,CT angiography(CTA)and/or digital subtraction angiography(DSA).Conformance testing of CDU with CTA and/or DSA.CDU,CTA and/or DSA findings consistent with 150 patients.According to whether having unilateral vertebral artery stenosis or not,they were divided into a stenotic group(n= 100,54 males and 46 females,aged from 35 to 76 years,mean: 42±11 years)and a simple vertebral artery hypoplasia(VAH)group(n=50,23 males and 27 females,aged from20 to 57 years,mean: 30±10 years).Control group: 100 healthy people were enrolled inthis study,including 57 males and 43 females,aged from 23 to 65 years,mean: 38±11years),with bilateral VAD>2.5mm,with no stenosis in whole course of vertebral artery.Inclusion criteria:(1)Image data inculded CDU with CTA and/or DSA wee integrity;(2)Stenotic group: unilateral vertebral artery diameter(VAD)?2.5 mm or compared with the contralateral side VAD ratio<1/1.7,intracranial stenosis of vertebral artery;(3)VAH group:unilateral VAD?2.5 mm or compared with VAD ratio of the contralateral side <1/1.7,the whole vertebral artery without stenosis.Exclusion criteria:(1)Bilateral VA stenosis or vertebral artery hypoplasia;(2)There were moderate or severe stenosis of internal carotid artery or middle cerebral artery,stenosis of extracranial segment of vertebral artery or subclavian artery,occlusion of intracranial segment of VA and so on;(3)Takayasu arteritis or moyamoya disease;(4)Non vascular dizziness or headache,such as brain tumors;(5)Pregnant women and children;(6)Patients with atrial fibrillation and other arrhythmias;(7)With no informed consent.The vertebral artery diameter(VAD),peak systolic velocity(PSV),end diastolic velocity(EDV),resistance index(RI),and the mean flow peak velocity were recorded by color Doppler flow imaging.The differences of blood flow of vertebral artery and resistance index were calculated.Evaluated the consistency of CDU with CTA and/or DSA by Kappa test.The differences of hemodynamic parameters among the 3 groups were compared by single factor analysis of variance,and the affected sides of the stenotic group,the VAH side of the simple VAH group,and the right side of the control group were compared with the pairwise comparison.The feasibility of different parameters for the diagnosis of intracranial stenosis of vertebral artery were evaluated by ROC curve analysis.Results1.Consistency analysis: CDU diagnosis of intracranial stenosis in VA was consistent with CTA and/or DSA(Kappa =0.8743,p<0.05).2.The accuracy of diagnosing VA intracranial stenosis by RI in VA intervertebral segment is higher: The diagnostic accuracy of the RI of the intervertebral segment of vertebral artery was higher,the resistance index difference and EDV had certain accuracy,while the accuracy of PSV was poorer,in which the resistance index of the intervertebral segment of vertebral artery was 0.754,the resistance index difference was 0.151 and EDVwas 9.5cm/s(Youden index were 0.695,0.605 and 0.495,respectively;Sensitivity were83.8%,63.6% and 81.6%,respectively;Specificity were 85.7%,96.9% and 67.9%,respectively;Accuracy were 87.3%,80.2% and 67.7%,respectively)were the optimal boundary values for diagnosing intracranial stenosis of vertebral artery.3.The blood flow and VAD diagnosis of intracranial stenosis of VA also have certain accuracy: blood flow was 56.52ml/min,VAD was 2.095mm(Youden index were 0.383 and0.381;Sensitivity were 89.8% and 87.6%,respectively;Specificity were 48.5% and 50.5%respectively;Accuracy were 79.5% and 65.2%,respectively).ConclusionDetecting vertebral artery intervertebral segment resistance index,resistance index difference,blood flow,end diastolic velocity,vertebral artery diameter with carotid Doppler ultrasonography can be used as a reference for evaluating intracranial stenosis of vertebral artery,and provide a basis for the early diagnosis of posterior circulation ischemia.Part ?: Investigate the correlation between different stenotic lesions of the intracranial vertebral artery and posterior circulation ischemiaObjiectiveInvestigate the correlation between different stenotic lesions of the vertebral artery and posterior circulation ischemia.MethedsBy CDU,CTA and/or DSA confirmed 362 cases of patients with unilateral VA stenosis or occlusion,which devide into affected side and healthy side.According to the relationship between the lesion and PICA,cases divided into before group of 73 cases and after the group of 289 cases.Posterior circulation ischemia: with limb/head facial numbness,weakness,headache,vomiting,diplopia,transient loss of consciousness,visual impairment,walking instability and falls.MRI-DWI had the blood supply area of focal ischemia of VA and PICA;With no posterior circulation ischemia: only with simple dizziness,vertigo,MRI-DWI can not see focal ischemia on VA and PICA supply area.According to posterior circulation ischemia,cases divided into PCI group of 133 cases,asymptomatic symptoms group of 229 cases.76 cases of intracranial VA severe stenosis symptoms(10 cases of PICA out before,after separation of 66 cases),167 cases of asymptomatic(6 cases of PICA out before,after separation of 161 cases);57 cases of intracranial VA occlusion with symptoms(51 cases of PICA out before,6 cases of PICA after separation),62 cases of asymptomatic(6 cases of PICA out before,after separation of 56 cases).Check the record CDU parameters: peak systolic velocity(PSV),end diastolic velocity(EDV),vascular resistance index(RI)and vertebral artery diameter(VAD),analysis of hemodynamic parameters and spectrum difference of VA;intracranial stenosis in different parts(PICA out before or after)was analyzed and the correlation between PCI symptoms.Comparison of VA stenosis and the contralateral side of the hemodynamic parameters by paired t test;different stenosis site hemodynamics of intracranial VA by using independent sample t test;correlation analysis of different parts of VA and PCI located onthe stenosis of intracranial lesions,using 2×2 crosstables Pearson chi square test and calculation dependence coefficient.Results1.Hemodynamic parameters associated with the site of PICA: The comparison of the ipsilateral VA and contralateral showed that PSV,EDV and RI,VAD had significant difference(p<0.05);The ipsilateral VA intervertebral segment PSV,EDV and RI were significantly related to position of PICA(P<0.05),but not VAD(p>0.05);2.The relationship with spectrum shape and the site of PICA: when the ipsilateral VA before PICA,intervertebral segment showed “spectrum unimodal” and after PICA showed “highresistance”.3.The relationship with VA intracranial lesions and PCI: VA intracranial severe stenosis in different site was not associated with the symptoms of PCI(dependence coefficient =0.023,p=0.782).VA intracranial occlusion in different site was associated with the symptoms of PCI significantly(dependence coefficient =0.623,p<0.05).Conclusion1.PCI is associated with the site of PICA.CDU can be used to evaluate the relationship between VA intracranial stenosis and PICA.2.CDU is a noninvasive,real time and dynamic assessment tool of VA intracranial lesions in different site.All of that can provide reliable basis for treatment and prognosis in clinical.