Hemodynamics alteration after the vertebral artery stenting in patients with bilateral vertebral artery severe stenosis and its relationship with restenosis / 中国脑血管病杂志

ABSTRACT

Objective: To investigate the effect of contralateral vertebral arterial hemodynamics after unilateral vertebral artery stenting and its relationship with restenosis. Methods: A total of 155 patients with severe stenosis (70-99%) at the origin of unilateral vertebral artery confirmed by digital subtract angiography (DSA) and underwent stent implantation were recruited in the study. According to the contralateral vertebral artery lesions, they were divided into 3 groups normal group (n = 71), severe stenosis group (n = 29 ) and occlusion group (n = 55). Carotid color Doppler flow imaging (CDFI) and transcranial Dopper (TCD) were performed before stenting, within 1 week, and 1 year after stenting. Peak systolic velocity (PSV) and end diastolic velocity (EDV) of vertebral arteries at the original part (OS), intervertebral segment(IV) and intracranial (IC) segments were recorded. Results: Circled digit oneCompared to the normal group within 1 week after stenting, the PSVOS and EDV OS of the original part of the stent side vertebral artery in the severe stenosis group increased slightly, but there were no significant differences; the PSVOS and EDVOS in the occlusion group increased significantly (P < 0.05). The PSV and EDV of the intervertebral and intracranial segments at the stent side in the severe stenosis group and the occlusion group were significantly higher than those in the normal group (P < 0.05). The above parameters on the stent sides in the occlusion group were slightly higher than those in the severe stenosis group, but the difference was not statistically significant. Circled digit twoOne year after stenting, 79 patients were followed up with ultrasound. There were 35 patients in the normal group, 15 in the severe stenosis group, and 29 in the occlusion group. The severe stenosis group and occlusion group were combined and analyzed (lesion group). PSVos and EDVos of stent side in the lesion group were significantly higher than those in the normal group; the restenosis rate of stent side in the normal group was 34.3% (12/35), while that in the lesion group was 56.8% (25/44). There were significant difference between the two groups (P < 0.05). Circled digit threeMultivariate logistic regression analysis showed that the severe lesion (severe stenosis or occlusion) of the contralateral vertebral artery was an independent risk factor for restenosis on the stent side (OR, 3.261, 95% CI 1.174 to 9.058). Conclusion: When there is severe lesions at the original part of bilateral vertebral artery, the stent side of vertebral artery after stenting may immediately play a compensatory role for the blood flow on the non-stent side, however, this compensatory role is also one of the risk factors for occurring in-stent restenosis.