Bendick P J, Glover J L
William Beaumont Hospital, Royal Oak, Michigan.
Surg Clin North Am. 1990 Feb;70(1):235-44. doi: 10.1016/s0039-6109(16)45048-6.
In summary, vertebral artery hemodynamics can be readily evaluated both qualitatively and quantitatively. Duplex ultrasonography provides a very reliable noninvasive technique for this assessment. Flow in the vertebral artery system can be noninvasively quantified in greater than 95 per cent of all patients examined using this technique, and such measurements help identify subgroups of patients whose symptoms may be related to posterior circulation ischemia. Further evaluation of the spectral flow patterns is often helpful in diagnosing the cause of these ischemic symptoms. Unfortunately, quantitative flows are rarely obtained during routine carotid ultrasound studies. Such data, however, may provide an objective basis for the following kinds of surgical decisions: 1. Recommendations for carotid surgery in patients with high-grade carotid stenosis but nonlocalizing symptoms. 2. Recommendations for no surgery in patients who have vertebrobasilar symptoms but diminished flow characteristic of poor cardiac output. 3. Recommendations for surgery to augment vertebral artery flow in patients who have vertebrobasilar symptoms, decreased vertebral flow on the basis of proximal stenosis, and normal carotid artery flow. Obviously, there is a need to confirm these hypotheses by studying patients thoroughly before and after surgery. Other investigators must begin gathering data on vertebral artery flow to determine its impact and utility in making surgical decisions.
总之，椎动脉血流动力学可通过定性和定量的方法轻松评估。双功超声检查为这种评估提供了一种非常可靠的非侵入性技术。使用该技术，在超过95%的受检患者中可对椎动脉系统的血流进行非侵入性定量，此类测量有助于识别症状可能与后循环缺血相关的患者亚组。进一步评估频谱血流模式通常有助于诊断这些缺血症状的病因。不幸的是，在常规颈动脉超声检查中很少获得定量血流数据。然而，此类数据可为以下几种手术决策提供客观依据：1. 对有重度颈动脉狭窄但无定位症状的患者进行颈动脉手术的建议。2. 对有椎基底动脉症状但因心输出量低而血流减少的患者不进行手术的建议。3. 对有椎基底动脉症状、因近端狭窄导致椎动脉血流减少且颈动脉血流正常的患者进行手术以增加椎动脉血流的建议。显然，有必要通过对患者手术前后进行全面研究来证实这些假设。其他研究人员必须开始收集椎动脉血流数据，以确定其在手术决策中的影响和效用。
