Grant Edward G, El-Saden Suzie M, Madrazo Beatrice L, Baker J Dennis, Kliewer Mark A
Department of Radiology, University of Southern California Keck School of Medicine, University Hospital, 1500 San Pablo St., Los Angeles, CA 90033, USA.
AJR Am J Roentgenol. 2006 Feb;186(2):394-400. doi: 10.2214/AJR.04.1000.
The objective of this study was to report the sonographic abnormalities in a group of patients with angiographically proven innominate artery stenosis and occlusion.
A review of all cerebrovascular sonograms at our institutions was undertaken to identify patients with complete or partial flow reversal in the right vertebral artery and reversal or midsystolic deceleration of flow in any one of the three major segments of the right carotid system (common, internal, or external carotid artery). The distribution and appearance of these abnormalities was evaluated, and the presence or absence of tardus-parvus waveforms was noted in any segment of the right carotid artery. Additionally, a left to right common carotid peak systolic velocity ratio (LCCA/RCCA) was calculated and compared to published normal values. All patients had correlative contrast or MR angiography. Correlation was made between the severity of stenosis as determined by angiographic images and waveform aberrations as well as the more objective LCCA/RCCA ratios.
Twelve patients were identified as having the abnormalities described above in the right vertebral and carotid arteries. Doppler waveforms from the right vertebral artery revealed that eight of the 12 patients had complete reversal of flow at rest. Bidirectional flow was found in the remaining four as manifested by the presence of marked midsystolic deceleration. In the carotid arteries, one patient had complete reversal of flow in all segments of the right carotid system. Waveforms with midsystolic deceleration were identified in at least one of the carotid arteries of the remaining 11 patients: common carotid artery (8/11 = 73%), internal carotid artery (10/11 = 91%), external carotid artery (3/11 = 27%). The average LCCA/RCCA was 3.1 with a range of 1.7 to 5.7 (normal = 0.7-1.3). All patients had severe innominate artery disease (from 70% to occlusion) by contrast angiography or MR angiography. There was no correlation between the angiographically determined degree of stenosis and the Doppler findings.
A distinctive pattern of hemodynamic alterations occurs in the right vertebral and carotid arteries of patients with severe innominate artery disease. Findings include reversed or bidirectional flow in the right vertebral artery, the presence of midsystolic deceleration in any of the branches of the right carotid system, and elevated LCCA/RCCA ratio.
本研究的目的是报告一组经血管造影证实无名动脉狭窄和闭塞患者的超声异常表现。
回顾我们机构所有的脑血管超声检查，以确定右椎动脉血流完全或部分逆转以及右颈动脉系统三个主要节段（颈总动脉、颈内动脉或颈外动脉）中任何一个节段血流逆转或收缩中期减速的患者。评估这些异常的分布和表现，并记录右颈动脉任何节段是否存在迟缓-低平波形。此外，计算左、右颈总动脉收缩期峰值流速比值（LCCA/RCCA），并与已发表的正常值进行比较。所有患者均进行了相关的对比血管造影或磁共振血管造影。对比血管造影图像确定的狭窄严重程度与波形异常以及更客观的LCCA/RCCA比值之间进行相关性分析。
12例患者被确定在右椎动脉和颈动脉存在上述异常。右椎动脉的多普勒波形显示，12例患者中有8例在静息时血流完全逆转。其余4例表现为明显的收缩中期减速，存在双向血流。在颈动脉中，1例患者右颈动脉系统所有节段血流完全逆转。其余11例患者至少有一条颈动脉出现收缩中期减速波形：颈总动脉（8/11 = 73%）、颈内动脉（10/11 = 91%）、颈外动脉（3/11 = 27%）。LCCA/RCCA的平均值为3.1，范围为1.7至5.7（正常范围 = 0.7 - 1.3）。所有患者经对比血管造影或磁共振血管造影均显示无名动脉严重病变（70%至闭塞）。血管造影确定的狭窄程度与多普勒检查结果之间无相关性。
严重无名动脉疾病患者的右椎动脉和颈动脉会出现独特的血流动力学改变模式。表现包括右椎动脉血流逆转或双向血流、右颈动脉系统任何分支出现收缩中期减速以及LCCA/RCCA比值升高。
