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Follow-Up of Extracranial Vertebral Artery Stents with Doppler Sonography

Fatih Kantarci1, Ismail Mihmanli1, Mehmet Sait Albayram2, Hakan Barutca1, Fatih Gulsen1, Naci Kocer2 and Civan Islak2

1 Department of Radiology, Division of Ultrasonography, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa 34300, Istanbul, Turkey.
2 Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.


Figure 1
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  		Fig. 1A —76-year-old woman with ischemic posterior circulation. Digital subtraction angiogram (DSA) of right vertebral artery (arrowhead) at anteroposterior projection reveals 75% stenosis (arrow) at vertebral artery origin. SCA = subclavian artery.

 

Figure 2
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  		Fig. 1B —76-year-old woman with ischemic posterior circulation. Follow-up DSA, anteroposterior projection, immediately after stent deployment shows total dilatation (arrow) of stenosis. SCA = subclavian artery, arrowhead indicates vertebral artery.

 

Figure 3
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  		Fig. 1C —76-year-old woman with ischemic posterior circulation. Immediate poststenting spectral Doppler sonogram from V2 segment of vertebral artery reveals peak systolic velocity of 57 cm/s, resistive index of 0.74, acceleration time of 60 milliseconds, absolute acceleration of 466 cm/s2, and blood flow volume of 174 mL/min.

 

Figure 4
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  		Fig. 1D —76-year-old woman with ischemic posterior circulation. Blood flow volume on first-year follow-up spectral Doppler sonogram preceeding follow-up angiogram shows peak systolic velocity of 67 cm/s, resistive index of 0.76, acceleration time of 60 milliseconds, absolute acceleration of 516 cm/s2, and blood flow volume of 194 mL/min.

 

Figure 5
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  		Fig. 1E —76-year-old woman with ischemic posterior circulation. First-year follow-up color Doppler sonogram provides direct evaluation and reveals normal color flow in stent (arrow). SCA = subclavian artery.

 

Figure 6
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  		Fig. 1F —76-year-old woman with ischemic posterior circulation. First-year follow-up vertebral artery (arrowhead) DSA in left anterior oblique projection shows good filling of stent lumen (arrow) with contrast material. No intimal hyperplasia is seen. SCA = subclavian artery.

 

Figure 7
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  		Fig. 2A —55-year-old man with ischemic posterior circulation. Digital subtraction angiogram (DSA), anteroposterior projection, reveals 95% stenosis at vertebral artery origin (arrow). Note that vertebral artery (arrowhead) filling is poor distal to stenosis. SCA = subclavian artery.

 

Figure 8
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  		Fig. 2B —55-year-old man with ischemic posterior circulation. Immediate follow-up DSA after stent deployment reveals total dilatation of stenotic segment (arrow) and good filling of vertebral artery (arrowhead). SCA = subclavian artery.

 

Figure 9
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  		Fig. 2C —55-year-old man with ischemic posterior circulation. Immediate poststenting spectral Doppler sonogram from V2 segment of vertebral artery reveals peak systolic velocity of 58 cm/s, resistive index of 0.69, acceleration time of 65 milliseconds, absolute acceleration of 430 cm/s2, and blood flow volume of 177 mL/min.

 

Figure 10
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  		Fig. 2D —55-year-old man with ischemic posterior circulation. Follow-up color Doppler sonogram of vertebral artery origin 9 months after stent deployment shows intimal hyperplasia (arrow), luminal narrowing, and color flow disturbance in stent.

 

Figure 11
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  		Fig. 2E —55-year-old man with ischemic posterior circulation. Spectral Doppler sonogram from this segment reveals jet flow (peak systolic velocity, 295 cm/s).

 

Figure 12
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  		Fig. 2F —55-year-old man with ischemic posterior circulation. V2 segment spectral analysis depicts decrease of peak systolic velocity (42 cm/s), resistive index (0.54), and blood flow volume (106 mL/min) when compared with immediate poststenting examination. Acceleration time is 50 milliseconds and absolute acceleration is 380 cm/s2.

 

Figure 13
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  		Fig. 2G —55-year-old man with ischemic posterior circulation. 9-month follow-up DSA immediately after Doppler follow-up examination confirms significant (50%) restenosis (large arrow) in stent. SCA = subclavian artery, arrowhead indicates vertebral artery, small arrows indicate stent struts.

 

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