颈动脉内膜剥脱与支架置入术患者围手术期脑灌注对比分析  

Carotid endarterectomy versus carotid artery stenting on cerebral perfusion in patients with carotid stenosis

作　　者：原野[1] 郭大乔[2] 符伟国[2] 蒋俊豪[2] 王利新[2] 唐骁[2] 

机构地区：[1]南京医科大学附属无锡市人民医院血管外科,江苏无锡214000 [2]复旦大学附属中山医院血管外科,上海200032

出　　处：《中国普通外科杂志》2015年第12期1727-1731,共5页China Journal of General Surgery

摘　　要：目的:通过全脑CT灌注成像(WBCTP)分析并比较颈动脉内膜剥脱术(CEA)与颈动脉支架成形术(CAS)对颈动脉狭窄患者围手术期脑灌注的影响及差异。方法:参照北美症状性颈动脉内膜切除术(NASCET)标准,选择32例经全脑动脉造影确诊颈动脉狭窄的患者,其中行CEA 11例、行CAS 21例。所有患者术前、术后1周均行WBCTP检查采集脑灌注数据,分析并比较两组相对脑血流量(r CBF)、相对脑血容量(r CBV)、相对平均通过时间(r MTT)的变化及差异。结果:与术前比较,两组患者术后r CBF、r CBV、r MTT均明显改善(均P<0.05),两组间以上指标变化程度均无统计学差异(均P>0.05)。结论:CEA、CAS两种术式均可改善颈动脉狭窄患者脑灌注,且疗效相似。Objective： To analyze and compare the influences of carotid endarterectomy （CEA） and carotid artery stenting （CAS） on cerebral perfusion in patients with carotid stenosis during perioperative period by means of whole brain computed tomography perfusion （WBCTP）. Methods： According to the criterion of the North American Symptomatic Carotid Endarterectomy Trial （NASCET）, 32 patients with carotid stenosis that was confirmed by whole brain angiography were selected. Of the patients, 11 cases underwent CEA, and 21 cases underwent CAS. All patients underwent WBCTP examination before and one week after operation, and the cerebral perfusion data were recorded. The changes and degrees of the changes in the perfusion parameters that included regional cerebral blood flow （rCBF）, regional cerebral blood volume （rCBV）, and regional mean transit time （rMTT） of the two groups of patients were analyzed and compared. Results： Compared with preoperative data, rCBF, rCBV and rMTT were all significantly improved in either group （all P〈0.05）, but the degrees of the changes in all parameters showed no significant difference between the two groups （all P〉0.05）. Conclusion： Both CEA and CAS procedures can improve the cerebral perfusion in patients with carotid artery stenosis, and they also exhibit similar efficacy.

关 键 词：颈动脉狭窄 动脉内膜切除术 支架 灌注成像 

分 类 号：R654.3[医药卫生—外科学]