Abstract 【Objective】To explore the relationship of hemodynamic parameters of severe stenosis or occlusion of vertebral artery (VA) with posterior circulation ischemia (PCI). 【Methods】From September 2019 to March 2021,150 patients with severe stenosis or occlusion of V1~V4 segment of unilateral VA diagnosed by carotid ultrasound,angiography and angiography were retrospectively analyzed. According to the location of severe stenosis or occlusion VA,they were divided into the V1 segment (84 cases),V2 segment (9 cases) and V3 ~ V4 segment (57 cases). Carotid artery ultrasound was used to check and record the hemodynamic parameters of each part of VA. ROC was used to analyze the hemodynamic parameters of V1~V4 segments to predict the value of severe stenosis or occlusion of VA. Logistic stepwise regression analysis was used to test the correlation between hemodynamic parameters and PCI. 【Results】In severe stenosis or occlusion of V1 and V2 segments,peak systolic blood velocity (PSV),end diastolic blood velocity (EDV) and vascular resistance index (RI) of the affected side were significantly lower than those of the healthy side,and the diameter of VA intervertebral segment (VAD) was thinner than that of the healthy side. When V3~V4 segment was severely narrowed or occluded,the PSV and EDV of the affected side were significantly lower than those of the healthy side,and the VAD was thinner than that of the healthy side (P<0.05). When V3~V4 segment was severely narrowed or occluded,there was no difference in RI between the affected side and the healthy side (P>0.05). Through ROC analysis,it was found that the levels of PSV,EDV,RI,VAD in V1~V2 and PSV,EDV and VAD levels in V3~V4 can be used to predict the severe stenosis or occlusion of VA. Multivariate analysis showed that there was no significant correlation between PCI and severe stenosis or occlusion in V1 and V2 segments,while PSV,EDV and VAD in V3~V4 segments were significantly correlated with PCI,which were independent risk factors for PCI,while RI in V3~V4 segments had no significant correlation with PCI. 【Conclusion】PCI is related to V3-V4 segment stenosis or occlusion. The lower PSV,EDV and the thinner VAD can increase the risk of PCI.
[1] MAIDA C D,NORRITO R L,DAIDONE M,et al. Neuroinflammatory mechanisms in ischemic stroke:focus on cardioembolic stroke,background,and therapeutic approaches[J].Int J Mol Sci,2020,21(18):6454. [2] MONTELLANO F A,UNGETHÜM K,RAMIRO L,et al. Role of blood-based biomarkers in ischemic stroke prognosis:a systematic review[J].Stroke,2021,52(2):543-551. [3] 冯增伟,韩宏彦,左云龙,等. 血管搭桥术治疗烟雾病合并后循环病变[J].中国临床研究,2021,34(8):1045-1048. [4] 边祥兵,林家骥,张森皓,等. 颅内椎-基底动脉夹层形态学与后循环缺血程度的相关性研究[J].中国卒中杂志,2021,16(5):440-445. [5] 叶晓燕. 颈动脉超声联合TCD在颈动脉、椎动脉支架术中的应用[J].重庆医学,2021,50(20):3502-3505. [6] 国家卫生计生委脑卒中防治工程委员会. 中国脑卒中血管超声检查指导规范[J].中华医学超声杂志(电子版),2015,12(8):599-610. [7] WANG J,MA Q,YANG Z,et al. Feasibility of evaluating the stenosis of intracranial segment in the vertebral artery using neck-brain integrated ultrasound:a comparison with computed tomography angiography and digital subtraction angiography[J].Ann Transl Med,2020,8(18):1155-1159. [8] 杜利勇,华扬,杨洁,等. 超声评价椎动脉颅外段狭窄闭塞性病变血运重建的成功性[J].中华医学超声杂志(电子版),2018,15(9):649-653. [9] 杨芳宇,刘佳明,高旭,等. 椎动脉V4段夹层动脉瘤引起低级别蛛网膜下腔出血行支架辅助栓塞的效果分析[J].中华外科杂志,2021,59(8):691-696. [10] 陈学丛,孔文婷,张跃其,等. 单侧颈动脉支架置入术后支架对侧颈动脉供血区微栓塞的危险因素研究[J].中国全科医学,2019,22(36):4434-4438. [11] 徐旭,张丽丽,程晖. 高微循环阻力指数和血浆致动脉硬化指数是STEMI患者PCI术后短期不良预后的危险因素[J].微循环学杂志,2021,31(3):18-21. [12] SZALONTAI L,JOKKELl Z,HORVATH T,et al. Are the morphological indices of the vertebrobasilar system heritable? A twin study based on 3d reconstructed models[J].Medicina (Kaunas),2021,57(2):127.
2022, Vol. 39 
