锁骨下动脉或无名动脉狭窄经皮血管内成形和支架术前后彩色多普勒超声的应用价值  

Application of color Doppler ultrasonography to stenosis of subclavian or innominate artery before and after percutaneous transluminal angioplasty and stent

作　　者：杨顺实[1] 吴亮[1] 徐武平 张临洪[2] 李渊[1] 周勤[1] 田冬荣[1] 毛明锋[1] 

机构地区：[1]武汉市中心医院超声影像科,430014 [2]武汉市中心医院神经内科,430014

出　　处：《中华超声影像学杂志》2009年第12期1046-1049,共4页Chinese Journal of Ultrasonography

摘　　要：目的探讨彩色多普勒超声在经皮血管内成形和支架 （percutaneous transluminal angioplasty and stent,PTAS）术前诊断锁骨下动脉或无名动脉 （subclavian or innominate artery,SIA） 狭窄和术后监测中的价值。方法选择45例SIA狭窄患者，应用彩色多普勒超声观察其颅外段椎动脉和锁骨下动脉。对其中36例单侧SIA狭窄患者进行椎动脉血流方向和频谱形态分析，根据椎动脉频谱形态变化进行盗血分级，并与定量血管造影对比。45例SIA狭窄患者中成功进行PTAS治疗36例（植入36个支架），测量支架植入术后支架处峰值流速（PSV）和术后随访速率比（VR）等血流动力学参数，观察支架有无术后再狭窄。结果36例单侧SIA狭窄患者中，彩色多普勒超声检测的盗血分级与定量血管造影检测的血管狭窄率呈显著性正相关性（r=0．752，P〈0．01）。36例支架植入患者随访至术后8～12月，4例发生再狭窄，其术后支架处PSV和VR明显高于未狭窄组（P〈0．01）。结论彩色多普勒超声是PTAS术前诊断SIA狭窄及术后监测的有效影像学手段。Objective To explore the value of color Doppler ultrasonography （CDU） as preoperative diagnosing and postoperative monitoring in patients with stenosis of subclavian or innominate artery（SIA） before and after percutaneous transluminal angioplasty and stent（PTAS）. Methods A total of 45 patients with stenosis of SIA were selected. Their extracranial vertebral artery and subclavian artery were observed with CDU. In 36 patients with one-sided stenosis of SIA, blood flow direction and spectrum of extracranial vertebral artery were analyzed. Subclavian steal grade confirmed by spectrum change of vertebral artery was compared with the stenosis grade on quantitative angiography （QA）. Among 45 patients with stenosis of SIA, PTAS was performed successfully in 36 patients（36 stents implanted）. After stents implanted, hemodynamic parameters such as peak systolic velocity （PSV） in stent, follow-up velocity ratio in stent （VR） were measured. Restenosis in stent were observed. Results In 36 patients with one sided stenosis of SIA, the ultrasonographic steal grade correlated with the QA stenosis grade significantly （ r = 0. 752, P 〈0. 01 ）. Among 36 patients with stent implanted, follow up 8- 12 months,4 patients with restenosis in stent were found. Compared with the patients without restenosis in stent, PSV and VR in stent increased significantly （ P 〈 0.01 ）. Conclusions As a fast and non invasive imaging technique,CDU could allow diagnosis of stenosis of SIA before PTAS,and detection of restenosis after PTAS.

关 键 词：超声检查 多普勒 彩色 锁骨下动脉窃血综合征 血管成形术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R654.3[医药卫生—诊断学]