血管超声评估颈内动脉闭塞血运重建复合手术的成功性  

Evaluation of the successful revascularization for internal carotid artery occlusion by vascular ultrasound

作　　者：周瑛华[1] 华扬[1] 王力力[1] 夏明钰[1] 段春[1] 凌晨[1] Zhou Yinghua;Hua Yang;Wang Lili;Xia Mingyu;Duan Chun;Ling Chen(Department ofVascular 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：《中华医学超声杂志（电子版）》2018年第9期667-672,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：首都卫生发展科研专项(首发2018-2-2011)

摘　　要：目的应用颈动脉彩色多普勒血流成像(CDFI)和经颅彩色多普勒超声(TCCS)评估颈内动脉闭塞患者行颈动脉内膜切除术(CEA)并取栓和(或)支架植入复合术的血运重建再通的成功性。方法回顾性连续纳入2007年1月至2018年1月在首都医科大学宣武医院经(DSA)确诊为颈内动脉闭塞,并接受复合手术治疗的患者78例。术前1周和术后1周内行CDFI和TCCS检查。分析比较术前颈内动脉近段及远段内径、闭塞管腔内病变回声、责任斑块长度、交通支开放(眼动脉血流方向逆转)与否等因素对复合手术血运重建再通成功性的影响。结果 78例患者复合手术再通成功率为78.2%(61/78)。围手术期并发症的发生率为6.4%。多因素Logistic回归分析结果显示,闭塞管腔内均质回声、眼动脉血流方向逆转均是颈内动脉闭塞再通成功性的独立影响因素(OR=0.069,95%CI:0.045～0.604,P=0.007;OR=0.164,95%CI:0.009～0.501,P=0.008)。结论闭塞管腔内的回声性质、眼动脉方向的逆转与颈内动脉闭塞后血运重建的再通率密切相关。CDFI与TCCS联合评估颈内动脉闭塞复合手术的成功性具有重要的价值。ObjectiveTo evaluate the successful revascularization in patients with internal carotid artery occlusion （ICAO） after carotid endarterectomy （CEA）, arterial embolectomy （CEA ＆ AEmb） or CEA and stent implantation （CEA ＆ Stent） using color doppler flow imaging （CDFI） and transcranial color-coded sonography （TCCS）. MethodsFrom January 2007 to January 2018, a total of 78 patients with ICAO con？rmed by DSA and treated with CEA ＆ AEmb or CEA ＆ Stent were included in this study. CDFI and TCCS were completed in a week before and after surgery. The in？uence factor for success of recanalization were recorded and analyzed, such as diameters proximal and distal to the internal carotid artery （ICA）, echo characteristics in the lumen of ICA, length of the plaque and thrombus, collateral circulation established （The blood ？ow of the ophthalmic artery reversed）. ResultsThe rate of complete recanalization was 78.2% （61/78）, while 17 patients were failed （15 had occlusion and 2 had severeresidual stenosis）. The incidence of perioperative complications was 6.4%. Multiple logistic regression analysis showed that homogeneous echo intra-ICA （OR=0.069, 95%CI： 0.045-0.604, P=0.007） and flow reversal of the ophthalmic artery （OR=0.164, 95%CI： 0.009-0.501, P=0.008） were independent in？uence factors for recanalization rate. There was no signi？cant difference in the effect on the rate of recanalization between the proximal and distal to ICA diameter （P=0.078）. ConclusionsThe echogenicity intra lumen of ICAO and the reversed direction of the ophthalmic artery are closely related to the rate of recanalization. It is of the great predictive value to evaluate the success of ICAO combined CDFI with TCCS.

关 键 词：颈内动脉闭塞 颈动脉内膜切除术 动脉取栓 支架 超声检查 多普勒 彩色 超声检查 多普勒 经颅 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.4[医药卫生—诊断学]