Ackerstaff R G, Grosveld W J, Eikelboom B C, Ludwig J W
Department of Clinical Neurophysiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Eur J Vasc Surg. 1988 Dec;2(6):387-93. doi: 10.1016/s0950-821x(88)80017-3.
A routine duplex investigation of the prevertebral segment of the vertebral artery was carried out in 2814 consecutive patients who were suspected for extracranial cerebral atherosclerosis. Depending on local anatomical properties duplex scanning failed to make a decision about the state of the ostium of the vertebral artery in 24% of the cases. This occurred in approximately three quarters of the cases on the left side. With regard to the state of the ostium of the vertebral artery, we compared the data of duplex scanning with those of intra-arterial contrast angiography in 211 patients. For the detection of a stenosis with a diameter reduction of 50% or more at the site of the ostium, duplex scanning has respectively a sensitivity of 0.80, a specificity of 0.92, a positive predictive value of 0.73, and a negative predictive value of 0.94. Eighty-seven percent of the occluded vertebral arteries were correctly identified. In some patients with severe multi-vessel disease, a high-flow or a low-flow state of the vertebral artery or a subclavian steal syndrome did not allow a correct decision with the duplex scanner about the state of the ostium of the vertebral artery. Significant atherosclerotic lesions of the remaining part of the prevertebral segment of the vertebral artery were rare. However, this study shows that duplex scanning of this segment is very well possible and in most cases the results of the non-invasive test were in accordance with those of arteriography.
对2814例疑似颅外脑动脉粥样硬化的连续患者进行了椎动脉椎前段的常规双功超声检查。根据局部解剖特性，在24%的病例中，双功扫描无法判断椎动脉开口的状态。这种情况大约四分之三发生在左侧。关于椎动脉开口的状态，我们在211例患者中比较了双功扫描与动脉内对比血管造影的数据。对于检测椎动脉开口处直径缩小50%或更多的狭窄，双功扫描的敏感性分别为0.80，特异性为0.92，阳性预测值为0.73，阴性预测值为0.94。87%的闭塞性椎动脉被正确识别。在一些患有严重多支血管疾病的患者中，椎动脉的高流量或低流量状态或锁骨下窃血综合征使得双功扫描仪无法正确判断椎动脉开口的状态。椎动脉椎前段其余部分的明显动脉粥样硬化病变很少见。然而，这项研究表明对该段进行双功扫描是非常可行的，并且在大多数情况下，无创检查的结果与动脉造影的结果一致。
