Relationship between vertebral artery incisures and the diseased regions evaluated using transcranial Doppler ultrasound / 中华医学超声杂志（电子版）

ABSTRACT

Objective To explore the relationship between the incisure changes in the intracranial vertebral artery (VA) segments on transcranial Doppler (TCD) and their diseased regions. Methods Incisure changes in VA intraeranial segments on TCD in 24 cases were found. Digital subtract angiography (DSA), computed tomography angiography (CTA)or coler Doppler flow imaging (CDFI)of carotid arteries were performed to confirm their diseased regions. Results (1)The group with end-systolic and pre-diatolic wide incisures was found in 9 cases DSA or CTA showed 5 cases with severe stenosis, 2 cases with occlusion and 2 cases with congenital tenuity of the affected vertebral artery proximal part(VA-Pr). Within the above 8 cases, ipsilateral subclavian artery (SubA) was normal, 1 case was complicated with moderate stenosis of ipsilateral SubA,and 1 case was complicated with occlusion of contralateral SubA. Haemodynamics test showed (1)negative; (2)The group with systolic incisures was in 12 cases, and 12 patients were divided into two groups based on the haemodynamics test ① positive group was in 6 cases. DSA showed that VA-Pr was normal but SubA had impaired with different degrees; ② negative group was in 6 cases. DSA showed VA-Pr was with occlusion in 4 cases and 2 cases was with congenital tenuity; The above 2 cases were complicated with stenosis of ipsilateral SubA and in 4 cases ipsilateral SubA were normal; (3) The group with small vibrated sharp waves on Doppler was in 3 cases, and DSA showed VA-Pr occlusion in 3 cases. In the 3 cases,one case was complicated with occlusion of ipsilateral SubA. Blood stealing was present in cervical muscular branches but not present between vertebral arteries . Ipsilateral SubA were normal in 2 cases. Haemodynamic tests showed negative. Conclusions VA incisures were not only present in the early subclavian steal syndrome (SSS) but also were found in the patients with impaired SubA . However, blood steal pathway is imperfect, and would be found in affected VA-Pr or congenital tenuity. Haemodynamic tests can help identify the above situation. The TCD screening method can be used in the routine diagnosis for SubA and VA from proximal to intracranial segments involvement, but there are limitations to some extent. It needs to combine with DSA and CDFI for diagnosis.