Blood Flow Velocity In Vertebral Arteries Research Articles

Effects of butylphthalide on cerebral vascular circulation, coagulation function, and neurological function in patients with acute severe ischemic stroke following intravenous thrombolysis: a preliminary study

Objective To analyze the effects of Butylphthalide on cerebral vascular circulation, coagulation function, and neurological function in patients with acute severe ischemic stroke following intravenous thrombolysis. Methods Clinical efficacy, cerebral vascular circulation indicators [anterior cerebral artery (ACA), middle cerebral artery (MCA), vertebral artery (VA) blood flow velocity], coagulation function indicators [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB)], neurological function indicators [Activities of Daily Living (ADL) score. Results The total effective rate of treatment in the control group was 76.47%, while in the observation group, it was 96.08%, with the observation group showing a significantly higher total effective rate than the control group (p < 0.05). Before treatment, there was no significant difference in ACA, MCA, and VA blood flow velocity between the two groups (p > 0.05). However, after treatment, the ACA, MCA, and VA blood flow velocity in the observation group were significantly higher than those in the control group (p < 0.05). Before treatment, there was no significant difference in PT, APTT, TT, and FIB levels between the two groups (p > 0.05). Conclusion In patients with acute severe ischemic stroke undergoing intravenous thrombolysis, the addition of Butylphthalide to the treatment regimen yields favorable clinical outcomes. Compared to Alteplase alone, the addition of Butylphthalide further improves cerebral vascular circulation and coagulation function, promoting the recovery and reconstruction of neurological function in patients. Importantly, the addition of Butylphthalide does not increase the risk of adverse reactions, making it a safe and ideal option for clinical application.

Effect of combined use of Buyang Huanwu decoction and olanzapine on clinical symptoms, neurological function, and degree of dementia in patients with vascular dementia after cerebral ischemic stroke

Purpose: To determine the efficacy and safety of Buyang Huanwu Decoction (BHD) + olanzapine in the treatment of vascular dementia (VD) after cerebral ischemic stroke (CIS).Methods: Ninety patients with VD after CIS were assigned to 2 groups: a conventional group treated with olanzapine, and a combination group given olanzapine + BHD. Traditional Chinese medicine (TCM) symptom score was evaluated in each group. Neurological function, degree of dementia, and activities of daily living (ADL) were evaluated using National Institute of Health Stroke Scale (NIHSS), Clinical Dementia Rating (CDR) scale, and ADL scale, respectively. Levels of inflammatory factors, oxidative stress, and neurotrophic factors in peripheral blood were also determined. Middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), and vertebral artery (VA) blood flow velocity (BFV) were assessed. Therapeutic effects and adverse reactions (ARs) were recorded as well.Results: The TCM symptom, NHSS, and CDR scores were decreased in the combination group, while ADL scores were increased (p &lt; 0.05). Levels of hs-CRP, IL-6, and malondialdehyde (MDA) also decreased, while IL-10, GPx, SOD, NT3, MCA, ACA, PVA, and VA BFV, and BDNF levels increased (p &lt; 0.05). Clinical effectiveness (CE) levels in the conventional and combination groups were 73.3 and 93.3 %, while the incidence of ARs were 11.11 and 6.7 %, respectively (p &lt; 0.05).Conclusion: Olanzapine + BHD mitigates clinical symptoms, enhances neurological function, decreases the degree of dementia, and increases ADL in patients with vascular dementia after CIS. Moreover, it improves cerebral blood flow, and it is safe to use. An increase in sample size will be needed to compare the long-term efficacy of olanzapine alone, and that of its combination with BHD in the treatment of VD after CIS.

Orthostatic hemodynamics in the vertebral artery and blood pressure in patients with orthostatic dizziness/vertigo

ObjectivesOrthostatic dizziness/vertigo (ODV) is a common symptom and is believed to occur due to the cerebral hypoperfusion caused by orthostatic hypotension (OH). However, the detailed mechanism underlying ODV onset is poorly understood. The vertebral artery (VA) mainly supplies blood to the central vestibular system; therefore, the orthostatic decrease of VA blood flow could possibly lead to ODV. This study investigated the orthostatic blood pressure and VA hemodynamics in ODV patients to elucidate the hemodynamic mechanism underlying ODV onset. Furthermore, the influence of orthostatic hypotension (OH) on VA hemodynamics was examined because OH is probably the most common cause of ODV. MethodsThis study included 181 patients with ODV and 73 control patients without ODV. All subjects underwent an active standing test to measure the extracranial Doppler (ECD) sonography spectrum of the VA and blood pressure (BP). VA blood flow velocity and BP were simultaneously measured for each patient in the supine static position and then in the upright standing positions following 3 min of standing. We investigated the orthostatic change in the average of flow velocity in bilateral VAs (VAFV) and BP for ODV patients compared with the control patients. ResultVAFV in ODV patients was significantly reduced when standing up compared with the control patients. In the ODV patients, there was no difference in orthostatic decrease in VAFV between patients those with OH and without OH. However, the VAFV in the standing position was significantly lower in patients with OH than without OH. In cases with OH, the ODV patients exhibited a greater decrease in VAFV compared with the control patients, but this was not statistically significant. In the absence of OH, a significantly greater orthostatic decrease in VAFV was observed in ODV patients compared with the controls. ConclusionOur findings suggest that the orthostatic decrease of VA blood flow is deeply involved in the hemodynamic mechanism underlying ODV onset and is possibly associated with OH and other etiologies.

Efficacy of Jianpi Huatan Dingxuan Decoction in the Treatment of Vertigo and Phlegm Obstruction Syndrome

Objective: To explore the clinical effect of the application of Jianpi Huatan Dingxuan Decoction in the treatment of patients with vertigo and phlegm obstruction. Method: The research work was started in Henan Provincial Hospital of Traditional Chinese Medicine. The work will be carried out from October 2019 to October 2020. The patients are all patients with vertigo and phlegm obstruction syndrome who received treatment during this period. 100 of them were selected as this time. The study subjects were randomly divided into two groups, the control group given conventional western medicine treatment and the experimental group given Jianpi Huatan Dingxuan Decoction. The treatment effects of the two groups were compared and analyzed. Results: The treatment efficiency and nursing satisfaction of the experimental group were 96.00% and 94.00% respectively, which were significantly higher than the 82.00% and 78.00% of the control group. Before treatment, the vertebrobasilar blood flow velocity of the patients was relatively low, P&gt;0.05. After the treatment intervention, the vertebral artery blood flow velocity and the basilar artery blood flow velocity of the experimental group were significantly higher than those of the control group. The data differed greatly. P&lt;0.05, the experimental group had better results. Conclusion: The application of Jianpi Huatan Dingxuan Decoction in the treatment of patients with vertigo and phlegm obstruction has a significant effect, which can promote the recovery of patients, improve the effective rate of clinical treatment, and has positive significance for clinical development.

Intraoperative Doppler ultrasound as a means of preventing vertebral artery injury during Goel and Harms C1-C2 posterior arthrodesis: technical note.

Vertebral artery injury (VAI) is a potential catastrophic complication of Goel and Harms C1-C2 posterior arthrodesis. Meticulous study of preoperative spinal CT angiography together with neuronavigation plays a fundamental role in avoiding VAI. Doppler ultrasonography may be an additional intraoperative tool, providing real-time identification of the vertebral artery (VA) and thus helping its preservation.Thirty-three consecutive patients with unstable odontoid fractures underwent Goel and Harms C1-C2 posterior arthrodesis. Surgery was performed with the aid of lateral fluoroscopic control in 16 cases (control group) that was supplemented by Doppler ultrasonography in 17 cases (Doppler group). Two patients in each group had a C1 ponticulus posticus. In the Doppler group, Doppler probing was performed during lateral subperiosteal muscle dissection, stepwise drilling, and tapping. Blood flow velocity in the V3 segment of the VA was recorded before and after posterior arthrodesis. All patients had a 12-month outpatient follow-up, and outcome was assessed using the Smiley-Webster Pain Scale. Neither VAI nor postoperative neurological impairments were observed in the Doppler group. In the control group, VAIs occurred in the 2 patients with C1 ponticulus posticus. In the Doppler group, 1 patient needed intra- and postoperative blood transfusions, and no difference in terms of Doppler signal or VA blood flow velocity was detected before and after C1-C2 posterior arthrodesis. In the control group, 3 patients needed intra- and postoperative blood transfusions.Useful in supporting fluoroscopy-assisted procedures, intraoperative Doppler may play a significant role even during surgeries in which neuronavigation is used, reducing the chance of a mismatch between the view on the neuronavigation screen and the actual course of the VA in the operative field and supplying the additional data of blood flow velocity.

The application of a pre-positioned upper cervical traction mobilization to patients with painful active cervical rotation impairment: A case series

Cervical mobilization and manipulation have been shown to improve cervical range of motion and pain. Cervical rotatory thrust manipulation has been associated with adverse patient reaction and damage to the V3 segment of the vertebral artery (VA). To document and describe the effects of an upper cervical (UC) traction based mobilization on participants with restricted and painful cervical rotation and to document if the mobilization changed blood flow velocity through the vertebral artery. This case series examined the effects of a traction based spinal mobilization on two different groups of participants. Group I included 93 participants with restricted bilateral cervical rotation that was also painful at end range. Group II included 30 different participants whose VA blood flow velocity was examined during the same mobilization. Pre- and post-mobilization active cervical rotation, pain intensity levels, and VA blood flow velocity during mobilization was documented. Paired T-tests were used to determine statistical significance for changes in cervical rotation, and VA blood flow velocity during mobilization. Ninety-three participants in group I demonstrated an average increase of 16 degrees of cervical rotation. No participant demonstrated an increase in pain, and no participant in group II (N= 30) demonstrated a change in VA blood flow velocity. The application this UC traction based mobilization improved active cervical rotation, end range rotation pain response, did not cause pain during its application and did not alter blood flow through the VA during application.

Influence of VA Hemodynamics on Orthostatic Vertigo

Objective: Orthostatic vertigo (OV) is believed to occur because of hypoperfusion of the brain with orthostatic decrease in blood pressure (BP). We investigated the relationship between the orthostatic hypotension (OH) and orthostatic decrease in vertebral artery blood flow velocity (VAFV) in order to determine whether these 2 factors could trigger OV. Method: In 251 subjects, BP and extracranial doppler sonography spectrum of the VA were recorded in the supine and standing positions. Subjects were categorized into the OH and non-OH groups, and the orthostatic decrease in VAFV in patients with and without OV was evaluated in each group. Results: The OH and non-OH group comprised 40 and 211 patients, respectively. The OH group included 29 patients with OV and 11 patients without OV. The non-OH group included 150 patients with OV and 62 patients without OV. In the OH group, the OV patients exhibited a marked orthostatic decrease in VAFV as compared with those without OV. In the non-OH group, the orthostatic decrease in VAFV was significantly greater in OV patients than in those without OV. Conclusion: Our results suggest that decrease in VAFV induced by standing could trigger OV, irrespective of OH status.

Influence of the orthostatic decrease in blood pressure and vertebral arterial hemodynamics on orthostatic vertigo

Orthostatic vertigo (OV) is believed to occur due to hypoperfusion of the brain with the orthostatic decrease in blood pressure (BP). However, in some cases the orthostatic decrease in blood pressure is not directly involved in the onset of OV. Since the vertebral artery (VA) supplies the central vestibular system, which is involved in the onset of vertigo, we investigated the relationship between the orthostatic changes in blood pressure and the changes in VA hemodynamics to determine whether those could affect the incidence of OV. In 251 subjects, extracranial ultrasonic doppler sonography (ECD) was performed to measure the VA blood flow velocity (VAFV) in the supine and standing position, and we also examined the orthostatic changes in BP. Orthostatic hypotension (OH) was defined as a systolic BP decrease of more than 20 mmHg when standing. All subjects were classified as the OH group and the non-OH group, and the orthostatic decrease in VAFV were evaluated in the cases with OV and without OV about each group, respectively. In the OH group, the cases with OV exhibited a great orthostatic decrease in VAFV compared with those without OV. In the non-OH group, the orthostatic decrease in VAFV was significantly greater in cases with OV than those without OV. These results suggest that the decrease in VAFV induced by standing involves the incidence of OV.

Vertebral Artery Blood flow Velocity Changes Associated with Cervical Spine rotation: A Meta-Analysis of the Evidence with implications for Professional Practice

Many studies of vertebral artery (VA) blood flow changes related to cervical spine rotation have been published, but the findings are controversial and the evidence unconvincing. Recent Doppler measurements suggest that contralateral VA blood flow is compromised on full rotation in both healthy subjects and patients. More rigorous research is needed, and it was the aim of this study to conduct a meta-analysis of published data to inform professional practice. A systematic literature search, including only Doppler studies of VA blood flow velocity associated with cervical spine rotation in adults, yielded nine reports with published data. Using weighted means of the pooled data, the magnitude of the effect size (Cohen's d) was calculated for differences between patients and subjects, sitting or lying supine for testing, the parts of the VA insonated, and the changes recorded after cervical spine rotation. From this meta-analysis, VA blood flow velocity was found to be compromised more in patients than healthy individuals, on contralateral rotation, with the subject sitting, and more in the intracranial compared to the cervical part of the VA. Possible reasons for these findings are suggested, and it is advised that sustained end-of-range rotation and quick-thrust rotational manipulations be avoided until there is a stronger evidence base for clinical practice.

Forty-six Cases of Vertebrobasilar Insufficiency Treated by Acupuncture plus Intravenous Infusion of Ligustrazine

To observe the therapeutic effect of acupuncture plus Ligustrazine on vertebrobasilar insufficiency (VBI) by transcranial Doppler (TCD) sonography. 86 VBI patients including 56 cases of low flow rate velocity type (LFVT) and 30 cases of high flow velocity type (HFVT) were randomly divided into Ligustrazine group (26 LFRT and 14 HFVT) and acupuncture plus Ligustrazine group (30 LFVT and 16 HFVT). The blood flow velocity (BFV) of vertebral artery (VA) and basilar artery (BA) in systole before and after treatment was measured with TCD and therapeutic effects were evaluated after 10 days' treatment in the two groups. In the acupuncture plus Ligustrazine group, the total effective rate was 93.3% and 88.5% in cases of LFVT and HFVT respectively, and BFV of VA and BA increased in LFVT patients while that in HFVT patients decreased significantly (P<0.05 or P<0.01). Owing to its dual regulation on blood flow of VA and BA, the therapeutic effect of acupuncture plus Ligustrazine was better than that of simple Ligustrazine.

Color duplex sonographic findings in human vertebral arteries during cervical rotation.

The aims of this study were to determine whether vertebral artery blood flow velocity changes during contralateral cervical rotation, to determine the extent of rotation necessary to affect the velocity, and to find direct evidence of stretching or compression of the vertebral arteries during cervical rotation. Color duplex sonography was used to measure the blood flow velocities and diameters of the vertebral arteries in 20 patients. Measurements were taken with the patients' heads in the neutral position and at 10 degrees increments of contralateral neck rotation (determined using a cervical range of motion goniometer) to the end-range. The data showed no significant change in the mean blood flow velocity for the entire study population during cervical rotation. However, there were marked changes in the blood flow velocities in 7 vertebral arteries toward the end-range of rotation. No arteries displayed any evidence of major stretching of the arterial walls, although localized compression of 2 arteries was observed. The results of this study suggest that vertebral arteries are usually unaffected by contralateral cervical rotation and that Doppler sonography may provide an indirect assessment of mechanical stresses to the arterial wall.

Ultrasonographic evaluation of vertebral artery to detect vertebrobasilar axis occlusion.

We performed the present study to determine whether the site of occlusion in the vertebrobasilar circulation could be identified by the measurement of blood flow velocity in the bilateral vertebral arteries. Using color-coded duplex carotid ultrasonography, we measured the time-averaged mean and end-diastolic flow velocities with incident angle correction in 130 bilateral vertebral arteries between the C3 and C6 segments of the spine in 65 stroke patients with or without occlusive diseases in the vertebrobasilar circulation. The site of occlusion was confirmed by cerebral angiography. The subjects included 12 patients with unilateral subclavian artery occlusion (SA group), 11 patients with unilateral occlusion at the origin of the vertebral artery (V1 group), 6 patients with unilateral vertebral artery occlusion before the branching of the posterior inferior cerebellar artery (V2 group), 14 patients with unilateral vertebral artery occlusion after the branching of the posterior inferior cerebellar artery (V3 group), 5 patients with basilar artery occlusion (BA group), 5 patients with unilateral posterior cerebral artery occlusion (PCA group), and 12 patients without any occlusive lesions in the vertebrobasilar circulation (control group). In the control group the mean and end-diastolic blood flow velocities were 25.5 +/- 6.9 cm/s and 16.2 +/- 4.3 cm/s, respectively, and the side-to-side differences of these velocities were 4.8 +/- 5.2 cm/s and 4.7 +/- 4.1 cm/s, respectively. All patients in the SA group demonstrated retrograde flow on the affected side. In the V1 group no flow signals were detected on the occluded side. In the V2 group the mean velocity (7.2 +/- 3.1 cm/s) was lower than in the control group, and the end-diastolic velocity was zero on the affected side. In the V3 group the mean and end-diastolic velocities (11.5 +/- 3.1 cm/s and 5.9 +/- 2.8 cm/s, respectively) on the occluded side were lower than in the control group. Flow velocities on the unaffected side were higher than those on the affected side in the SA, V1, V2, and V3 groups. However, there were no differences in flow velocity between the control, BA, and PCA groups. Measurement of vertebral artery blood flow velocity may help in localizing the site of occlusion in the subclavian and vertebral arteries.