摘要
目的评价经颅多普勒超声(TCD)在检测双侧颈内动脉病变患者支架置入术后脑血流动力学变化中的价值。方法选择经DSA证实的双侧颈内动脉颅外段(ICAe)重度狭窄(8例)或一侧重度狭窄、另一侧闭塞(10例)患者,共18例。应用TCD检测支架置入前、后颅内、外动脉血流动力学参数的变化。结果①TCD对ICAe闭塞诊断的敏感性为100%(10/10),对狭窄或闭塞诊断的特异性为96%(25/26),总体符合率为97%(35/36)。②术前ICAe狭窄段收缩期峰值流速(PSV)为(241±55)cm/s,术后1、3、6、12、24个月分别为(59±15)、(58±12)、(59±15)、(61±14)、(64±16)cm/s,与术前比较,差异均有统计学意义(P<0.01),而术后各阶段比较,差异无统计学意义。③术后支架侧大脑中动脉(MCA)的PSV较术前升高[(59±14)、(120±24)cm/s,P=0.000],血管搏动指数(PI)明显改善(0.64±0.15,1.05±0.19;P=0.000)。术后闭塞侧MCA的PSV亦有所升高[(48±17)、(70±16)cm/s,P=0.005],而PI值的变化不明显(P=0.379)。④术前有2例前交通动脉(AcoA)开放,双侧颈动脉置入支架后,AcoA关闭;术后有11例AcoA开放,其中10例为一侧闭塞,另一侧狭窄的患者,1例为双侧重度狭窄而仅一侧置入支架的患者。术前后交通动脉(PcoA)开放24支(10例为双侧同时开放,4例为单侧开放),术后18支PcoA关闭(6例为双侧同时期,6例为单侧关闭)。结论 TCD可用于双侧ICAe病变患者术前、术中、术后颅内外血流动力学变化的评估。
Objective To evaluate the value of transeranial Doppler ultrasonography （TCD） in detecting the changes of cerebral hemodynamics after bilateral internal carotid artery stenting. Methods A total of 18 patients with bilateral severe internal carotid artery （ICA） stenosis （n = 8 ） or severe stenosis on one side and occlusion on the other side （n = 10） were selected. TCD was used to detect the changes of hemodynamic parameters of extraeranial and intracranial artery before and after stenting. Results （1）TCD sensitivity for the diagnosis of ICA occlusion was 100% （10/10） , the specificity for the diagnosis of steno- sis or occlusion was 96% （25/26） , and the overall compliance rate was 97% （35/36）. （2）The preoperative peak systolic velocity （PSV） of the stenotie segment of extraeranial internal carotid artery （EICA） was 241 ± 55 cm/s; 1, 3, 6, 12, and 24 months after the procedure they were 59 ± 15, 58±12, 59 ± 15, 61 ± 14, and 64 ± 16 cm/s, respectively. Compared to those before the procedure, the differences were statistically significant. However, comparing to the various stages after the procedure, there were no statistical differences. （3）PSV of middle cerebral artery （MCA） on the stented side after the procedure was high- er than that before the procedure （59 ± 14, 120 ± 24 cm/s, P = 0.000）. Vascular pulsatility index （PI） was improved significantly （0. 64 ± 0. 15, 1.05 ± 0. 19 ;P = 0. 000）. PVS of MCA occlusion after the procedure was also increased slightly （48 ±17, 70 ± 16 cm/s, P = 0. 005）, while the changes of PI values was not significant （ P = 0. 379 ）. （4）Two patients had patent anterior communicating artery （AcoA） before the procedure, AcoA was occluded after bilateral carotid artery stenting; 11 patients had patent AcoA after the procedure, and 10 of them were unilateral occlusion and stenosis on the other side. One patient had bilater- al severe stenosis, but only had unilateral stenting. There were 24 （66. 7% ） patent posterior communicating arteries （PcoA） , 18 of them were occluded after the procedure. Conclusion TCD can be used in the evaluation of the extracranial and intracranial hemodynamic changes in patients with bilateral internal carotid artery disease before, during, and after the procedure.
出处
《中国脑血管病杂志》
CAS
2010年第11期596-600,共5页
Chinese Journal of Cerebrovascular Diseases
关键词
超声检查
多普勒
经颅
颈内动脉疾病
支架
双侧
Ultrasonography, Doppler, transcranial
Carotid artery diseases
Stents
Bilateral
