| The paper involved two aspects:(1)Feasibility of vascular ultrasound in evaluating extracranial vertebral artery dissection(VAD);(2)Correlation between extracranial VAD and posterior circulation ischemia.Part ?:Evaluation of the feasibility of extracranial vertebral artery dissection by carotid Dopplor ultrasonographyObjectiveCarotid Dopplor ultrasonography(CDU)is applied to assess the feasibility and reliability of the extracranial vertebral artery dissection(VAD).Metheds1.Clinical material:23 patients with head and neck pain,transient ischemic attack,or ischemic stroke who were treated at the stroke center of the First Affiliated Hospital of Suzhou University from November 2016 to November 2018 were included consecutively.Inclusion criteria:First received CDU and then completed high-resolution magnetic resonance imaging(HRMRI)of head and neck within 48 hours.Exclusion criteria:(1)cerebral infarction and cardiogenic embolism caused by atherosclerosis;(2)moyamoya disease or cerebral arteritis2.VAD types of CDU diagnosis:(1)double lumen:visible real cavity and false cavity.Visible blood flow signal in the real cavity,but blood flow signal was invisible in the false cavity;(2)intramural hematoma:the homogenous substance of low echo and regular edges filled the cavity,which caused the narrowing and occluding of the true cavity;(3)intimal flap:intimal floatation in damaged lumen;(4)aneurysmal dilatation:local lumen tumor-like expansion led to the narrowing and occluding of the true cavity.3.Statistical analysis:The Kappa consistency test was adopted to analyze the consistency of CDU and HRMRI,to evaluate the consistency of VAD,and to calculate the sensitivity,specificity,positive predictive value and negative predictive value of CDU by diagnosis of VAD.Results:1.CDU examination results:There are 29 vertebral artery dissections in 23 patients(6 bilateral),of which 93.2%(27/29)are intramural hematoma,3.4%(1/29)is double lumen,3.4%(1/29)is aneurysmal dilatation,and no intimal flap type is observed.2.Based on HRMRI diagnosis,the sensitivity of CDU in the diagnosis of VAD is 96.4%,the specificity is 88.9%,the positive predictive value is 93.1%,and the negative predictive value is 94.1%.3.Kappa test result:the consistency of CDU and HRMRI diagnosis of VAD is excellent(Kappa=0.862,P=0.000)Conclusion:1.The extracranial VAD is the most common type of intramural hematoma.2.The accuracy of adopting CDU to assess VAD in extracranial segment is considerably high,and it can be considered as a reliable method.Part ?:Correlation between extracranial vertebral artery dissection and posterior circulation ischemiaObjectiveTo investigate the correlation between the extracranial vertebral artery dissection(VAD)and posterior circulation ischemia,so as to provide a basis for clinical selection of individualized treatment options.Metheds1.Clinical material:46 patients with extracranial VAD diagnosed by carotid Dopplor ultrasonography(CDU)in the Department of Cervical and Cerebral Vascular Surgery of the First Affiliated Hospital of Suzhou University from November 2016 to October 2019 were consecutively included.Analysis of the relationship between the type of dissection and clinical outcome was conducted.Inclusion criteria:(1)CDU diagnosed as VAD and CT/MRI examination of the skull completed within 48 hours;(2)complete imaging and clinical data.Exclusion criteria:(1)atherosclerotic vertebral artery stenosis or occlusion;(2)patients with previous history of cerebral infarction.2.Study grouping:VAD in the extracranial segment were divided into occlusion group and non-occlusion group according to the fact that whether intraluminal hematoma caused luminal occlusion.If dissection occurred on both sides,the severe side was the main side to be evaluated and the correlation of VAD and cerebral infarction was evaluated for two cases.After standardized medical treatment,46 patients were followed up by CDU for 12 months to evaluate the recanalization of the lumen;According to the absorption of hematoma in the wall,it was divided into complete recanalization,partial recanalization,and no improvement.3.Statistical analysis:Chi-square test or continuous correction chi-square test were conducted to count data.When the sample size is insufficient,Fisher exact test is applied.The difference was statistically significant at P<0.05.Results:1.Correlations between VAD and cerebral infarction:46 cases of extracranial VAD patients with intramural hematoma accounted for 95.6%(44/46),double lumen accounted for 2.2%(1/46),aneurysmal dilatation took 2.2%(1/46),no floating type of valve was observed.Among them,the intramural hematoma occlusion group accounted for 20.5%(9/44),the incidence of cerebral infarction was 77.8%(7/9);the non-occlusive group was 79.5%(35/44),and the incidence of cerebral infarction was 31.4%(11/35),the difference between the two is statistically significant when P<0.05(P=0.032).2.Follow-up:46 cases of extracranial VAD patients were followed up by CDU for 12 months.A total of 37 cases were followed up and nine cases were not reviewed somehow.Intramural hematoma occlusion group was followed up for a total of 8 cases.The rate of complete recanalization of the lumen was 12.5%(1/8),the rate of incomplete recanalization was 37.5%(3/8),and the cases that the lumen was not improved and still occluded took for 50.0%(4/8).29 cases were followed up in the non-occluded group.The total recanalization rate of the lumen was 62.1%(18/29),the incomplete recanalization rate was 34.5%(10/29),and 3.4%(1/29)of the in-wall hematoma did not improve.There was a statistically significant difference in complete recanalization rate and no improvement in lumen between the two groups,both P<0.05(0.019 and 0.005 respectively).Conclusion:1.The incidence of cerebral infarction in vertebral artery dissection caused by intramural hematoma occlusion group was significantly higher than that of non-occlusion group.2.The luminal recanalization rate in the occlusion group was significantly lower in the occlusion group than in the non-occlusion group. |
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