颈内动脉极重度狭窄或闭塞后不全再通患者血运重建术前超声评估价值分析  

Value analysis of preoperative ultrasound assessment in patients with internal carotid artery extremely severe stenosis or incomplete recanalization after occlusion

作　　者：张楠[1] 华扬[1] 周瑛华[1] 杨洁[1] 杜利勇[1] 赵越[1] Zhang Nan;Hua Yang;Zhou Yinghua;Yang Jie(Du Liyon;Zhao Yu;Department of Vascular Ultrasonography,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053

出　　处：《中国脑血管病杂志》2018年第9期466-471,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：基于血管结构和血流动力学的血管超声综合评估体系量化预测颈动脉内膜切除手术风险的研究(首发2018-2-2011)

摘　　要：目的应用彩色多普勒血流显像及经颅彩色多普勒评估颈内动脉次全闭塞患者接受颈动脉内膜切除术(CEA)或复合手术(CEA+介入)前血管结构、血流动力学参数与血管再通的价值。方法回顾性连续纳入2006年1月至2018年1月就诊于首都医科大学宣武医院神经外科经DSA诊断为颈内动脉次全闭塞(狭窄率≥95.0%)、接受CEA治疗的患者共89例。根据术前超声对血管结构特征的评估,将89例颈内动脉次全闭塞患者分为颈内动脉极重度狭窄(ESS)组40例和颈内动脉闭塞不全再通(IRO)组49例。记录分析两组患者术前病变段血管内径、血流动力学参数与血管再通率的差异。结果所有患者血运重建的血管再通率为80.9%(72/89),ESS组血管再通率(90.0%,36/40)明显高于IRO组(73.5%,36/49,χ~2=3.894,P=0.048)。术前ESS组的颈内动脉远段内径小于IRO组[(2.2±0.4)mm比(2.8±0.9)mm,t=-3.901,P<0.01];ESS组最窄处收缩期峰值流速[295.0(190.7,400.2)cm/s]明显高于IRO组[82.0(37.0,164.5)cm/s,Z=-5.411,P<0.01],而狭窄远段收缩期峰值流速[13.0(8.2,19.0)cm/s]及舒张期末流速[6.0(4.0,9.7)cm/s]明显低于IRO组[分别为21.0(13.5,35.0)、9.0(6.0,14.5)cm/s],两组差异均有统计学意义(均P<0.01)。结论颈内动脉ESS患者CEA的血管再通率高于颈内动脉IRO患者,术前超声评估可明确颈内动脉次全闭塞病变类型,筛选手术病例,提高血管再通率。Objective To evaluate the value of color Doppler flow imaging and transcranial color Doppler on vascular structures,hemodynamic parameters and recanalization before receiving carotid endarterectom y（ CEA） or hybrid surgery（ CEA ＋ intervention） in patients with subtotal occlusion. Methods From January 2006 to January 2018,a total of 89 consecutive patients diagnosed as internal carotid artery subtotal occlusion（ stenosis rate ≥95. 0%） by digital subtraction angiography（ DSA）and treated with CEA were enrolled retrospectively. According to preoperative ultrasound evaluation of vascular structure characteristics,89 subtotal occlusion patients were divided into extremely severe stenosis（ ESS） group（ n = 40） and incomplete recanalization of occlusion（ IRO） group（ n = 49）. The differences of vascular diameter,hemodynamic parameters and vascular recanalization rate in the preoperative lesion segments between the two groups were recorded and analyzed. Results The recanalization rate of revascularization in patients of this study was 80. 9%（ 72/89）. The recanalization rate in the ESS group（ 90. 0%,36/40） was significantly higher than that in the IRO group（ 73. 5%,36/49,χ^2= 3. 894,P = 0. 048）. The distal diameter of internal carotid artery before procedure in the ESS group was less than that of the IRO group（ 2. 2 ±0. 4 mm vs. 2. 8 ± 0. 9 mm,t =-3. 901,P 〈0. 01）. The peak systolic velocity at the narrowest site in the ESS group（ 2 9 5. 0 [1 9 0. 7,4 0 0. 2] cm/s） was significantly higher than that in the IRO group（ 82. 0 [37. 0,164. 5]cm/s,Z =-5. 411,P 〈0. 01）,and the peak systolic velocity（ 13. 0[8. 2,19. 0]cm/s）and the end diastolic velocity（ 6. 0 [4. 0,9. 7]cm/s） of the distal stenosis were significantly lower than those in the IRO group（ 21. 0 [13. 5,35. 0]cm/s,9. 0 [6. 0,14. 5]cm/s respectively,all P 〈0. 0 1）.Conclusions The recanalization rate of CEA in patients with ESS was higher than that in patients with IRO. Preoperative ultrasound

关 键 词：颈内动脉 动脉闭塞性疾病 颈动脉内膜切除术 颈动脉狭窄 支架 彩色多普勒血流成像 次全闭塞 闭塞后不全再通 极重度狭窄 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.1[医药卫生—临床医学]