Harper Carl, Cardullo Paul A, Weyman Albert K, Patterson Robert B
University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
J Vasc Surg. 2008 Oct;48(4):859-64. doi: 10.1016/j.jvs.2008.05.057. Epub 2008 Aug 9.
Reversal of flow in the extracranial vertebral artery secondary to a proximal subclavian/innominate artery stenosis or occlusion is a frequent finding during carotid duplex ultrasonography. The characteristics of basilar artery flow are not well defined in these patients. The objective of this study is to evaluate basilar artery flow in patients with retrograde vertebral artery flow.
From a transforaminal vice transforamen approach with the patient seated, pulsed Doppler scan spectral waveforms were obtained from the distal segment of each vertebral artery (depths of 66 mm and 70 mm) and throughout the basilar artery (depths of 80 mm up to 116 mm). The direction of flow and the peak flow velocity were recorded at each location. In the subset of patients with antegrade flow, we initiated a 5-minute period of arm ischemia (produced by brachial blood pressure cuff inflated to a suprasystolic pressure) and compared flow direction to baseline.
Twenty-five patients with retrograde vertebral artery flow on carotid duplex ultrasonography underwent transcranial Doppler (TCD) ultrasonography scan of the distal vertebral arteries and the basilar artery. There were 10 males (58-85-years-old; mean 70.7 years) and 15 females (47-85-years-old; mean 66.0 years). An additional 11 patients who had normal vertebral flow underwent TCD and served as a control group. Nineteen patients (76%) demonstrated antegrade basilar artery flow at rest. Six patients (24%) demonstrated abnormal basilar artery flow at rest. Five had complete reversal of flow; one had intermittent flow reversal which became retrograde throughout the cardiac cycle following a period of arm ischemia ipsilateral to the patient's retrograde vertebral artery flow. No patient with retrograde vertebral artery flow and antegrade basilar artery flow at rest demonstrated a change in basilar artery peak velocity or direction of flow following arm ischemia.
Less than 25% of patients with retrograde vertebral artery flow on carotid duplex ultrasonography scan demonstrated a corresponding reversal of flow in the basilar artery. The vast majority of patients do not develop flow reversal in the basilar artery. Provocative maneuvers to increase collateral flow to the arm ipsilateral to retrograde vertebral artery flow did not appear to alter basilar artery flow velocity or direction of flow. Transcranial Doppler ultrasonography is indicated in patients with retrograde vertebral artery flow to document basilar artery flow, especially prior to intervention in patients with symptoms suggestive of posterior cerebral circulation insufficiency.
锁骨下动脉/无名动脉近端狭窄或闭塞继发的颅外椎动脉血流逆转是颈动脉双功超声检查时的常见发现。这些患者的基底动脉血流特征尚不明确。本研究的目的是评估椎动脉血流逆转患者的基底动脉血流情况。
患者坐位，采用经椎间孔入路，从每个椎动脉远端节段（深度66 mm和70 mm）以及整个基底动脉（深度80 mm至116 mm）获取脉冲多普勒扫描频谱波形。记录每个部位的血流方向和峰值流速。在顺行血流的患者亚组中，我们启动了5分钟的手臂缺血期（通过将肱动脉血压袖带充气至收缩压以上来产生），并将血流方向与基线进行比较。
25例颈动脉双功超声检查显示椎动脉血流逆转的患者接受了椎动脉远端和基底动脉的经颅多普勒（TCD）超声检查。其中男性10例（年龄58 - 85岁；平均70.7岁），女性15例（年龄47 - 85岁；平均66.0岁）。另外11例椎动脉血流正常的患者接受了TCD检查并作为对照组。19例患者（76%）静息时基底动脉血流呈顺行。6例患者（24%）静息时基底动脉血流异常。5例血流完全逆转；1例血流间歇性逆转，在与患者椎动脉血流逆转同侧的手臂缺血一段时间后，整个心动周期均变为逆行。没有静息时椎动脉血流逆转且基底动脉血流顺行的患者在手臂缺血后基底动脉峰值流速或血流方向出现变化。
颈动脉双功超声检查显示椎动脉血流逆转的患者中，不到25%的患者基底动脉血流相应逆转。绝大多数患者基底动脉未出现血流逆转。增加与椎动脉血流逆转同侧手臂侧支血流的激发动作似乎并未改变基底动脉血流速度或血流方向。对于椎动脉血流逆转的患者，建议进行经颅多普勒超声检查以记录基底动脉血流情况，尤其是在对有后循环供血不足症状的患者进行干预之前。
