椎基底动脉狭窄支架置入前后血流动力学变化的初步研究  

The preliminary study on hemodynamics change of brain before and after vertebrobasilar angioplas- ty and stenting in the patients with intracal stenosis

作　　者：陈茂华[1] 陆川[1] 孙军[1] 

机构地区：[1]温州市第二人民医院神经外科,浙江省温州325000

出　　处：《中国医师杂志》2012年第7期871-873,共3页Journal of Chinese Physician

基　　金：浙江省温州市科技计划项目（Y20100053）

摘　　要：目的探讨症状性椎基底动脉狭窄内支架成形术前后脑血流动力学变化。方法本研究纳入38例患者，全部经全脑DSA证实有单侧脑供血动脉狭窄（≥65％）。所有患者于血管内支架术前及术后48h内行经颅彩色多普勒（TCD）及脑CT灌注成像（CTP）检查，测量Vp、Vm、RI及CBV、CBF、MTT。结果38例患者行脑供血动脉狭窄内支架成形术前后动脉狭窄处血流速度峰值，由术前的（226±27）cm/s降至术后的（135±18）cm/s，差异有统计学意义（t=21．74，P〈0．01）。其中38个直接供血区术后rMTF较术前降低（t=3．987，P=0．001），37个直接供血区rCBF较术前增高（t=-2．027，P：0．029），38个直接供血区术后rCBV较术前无明显改变（t=-0．901，P=0．329）。结论经颅彩色多普勒（TCD）联合脑CT灌注成像是评估症状性椎基底动脉狭窄内支架成形术后脑灌注改善的指标。Objective To evaluate the hemodynamics change of brain before and after vertebrobasilar angioplasty and stenting in the patients with intracal stenosis. Methods All the indexes were compared among thirty-eight patients with intracal arterial stenosis, including mean peak flow velocity, systolic peak flow velocity, and resistance index of hemodynamics ; Cerebral blood volume （CBV） , cerebral blood flow （CBF）and middle time to peak（MTr） before and after the operation. Results After vertebro-basilar angioplasty and stenting in the 38 patients, the Vs of PCA were significantly lower in the affected side [ （226 ±27）cm/s vs （135 ± 18）cm/s; t =21.74, P 〈0. 011. Significant difference was found between pro-and post stenting of rMTF and rCBF in the blood territories of stenotic eerebrovascular （ t = 3. 987, P = 0. 001 ） and（ t = -2. 027, P = 0. 029 ）, There was no significant difference between pro-and post stenting of rCBV in the blood territories of stenotic cerebrovascular （ t = -0. 901, P = 0. 329）. Conclusions Transcranial Doppler and CT perfusion can be used to evaluate hemodynamic changes before and after percutaneous transluminal angioplasty and stenting.

关 键 词：椎底动脉供血不足/外科学 血管成形术 超声检查 多普勒 经颅 体层摄影术 螺 旋计算机 

分 类 号：R743.3[医药卫生—神经病学与精神病学]