支架成形术对大脑中动脉狭窄患者短期血液动力学的影响  

Hemodynamic changes in patients with symptomatic middle cerebral artery stenosis after stenting：a transcranial Doppler evaluation

作　　者：王桂红[1] 姜卫剑[1] 王拥军[1] 杜彬[2] 黄家星[3] 金旻[2] 王素香[1] 龚浠平[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经内科,北京100050 [2]首都医科大学附属北京天坛医院急诊介入科 [3]香港中文大学威尔斯亲王医院神经科

出　　处：《中华超声影像学杂志》2008年第5期426-429,共4页Chinese Journal of Ultrasonography

摘　　要：目的应用经颅多普勒超声（TCD）观察症状性大脑中动脉（MCA）狭窄患者支架成形术后短期内的血液动力学变化。方法对标准的抗血小板治疗期间仍有症状发作的29例MCA中重度狭窄患者31条MCA实施支架成形术，应用TCD系统评价术前、术后1h及3d内的MCA狭窄段及狭窄下游段的血液动力学变化。结果血管造影显示支架成形术后MCA的残余狭窄率均〈20％。与术前相比，术后1h及3d的收缩期峰值血流速度（PSV）明显下降[（162±38）cm／s对（273±77）cm／s，P＜0．01；（168±45）cm／s对（273±77）cm／s，P〈0．01]，术后1h及3d的PSV差异无统计学意义（P〉0．05）。3例患者（3条动脉）术后第3dTCD发现狭窄段又出现了狭窄样频谱，CT扫描显示2例颅内出血，1例无异常；至少28．6％（8／28）的患者狭窄下游段出现了PSV的成倍增加。对侧MCA支架成形术前后的PSV差异无统计学意义（P〉0．05）。结论支架成形术可明显改善MCA中重度狭窄患者狭窄段及狭窄下游段的血液动力学异常，但存在较高的过度灌注风险。Objective To investigate short-term hemodynamic changes in selected patients with middle cerebral artery（MCA） stenting by transcranial Doppler sonography（TCD）. Methods Stenting was given to 29 cases （31 MCAs） of patients with moderate and severe MCA stenosis if they had recurred symptoms during the standard antiplatelet therapy. TCD was applied to assess the hemodynamic changes in the stenosis segment and stenotic distal segment before stenting, 1 h and 3 d after stenting. Results Angiography showed that the rate of post-procedure residual stenoses of MCA were less than 20%. Compared with the pre-stentinng peak systolic velocity [PSV, （273 ± 77）cm/s], the post-stenting PSV significantly decreased, which was （162 ± 38） cm/s （P 〈 0. 01） at 1 hour and （168± 45）cm/s （ P〈0.01） at 3 days, respectively. Three cases （3 MCA） experienced recurrent stenosis-like spectra at stenosis segments 3 d after stenting and brain CT showed that 2 out of 3 cases suffered intracranial hemorrhage, which was potentially induced by hyperperfusion; PSV doubled in the stenotic distal segment in at least 28.6% patients. There was no statistic difference between pre- and post-stenting in the contralateral MCA （P 〉 0.05）. Conclusions Stenting can dramatically improve the hemodynamic compromise of stenosis segments and their distal segments in selected patients with symptomatic MCA stenosis, however, potential hyperperfusion risk might be taken into consideration after MCA stenting.

关 键 词：超声检查 多普勒 经颅 梗塞 大脑中动脉 支架 血液动力学现象 

分 类 号：R686[医药卫生—骨科学]