颈内动脉与椎动脉夹层的血管超声评估及管腔再通的差异性分析  

Vascular ultrasound assessment of internal carotid artery dissection and vertebral artery dissection and the difference analysis of lumen recanalization

作　　者：李兆强 华扬[1] 贾凌云[1] 杨洁[1] Li Zhaoqiang;Hua Yang;Jia Lingyun;Yang Jie(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》2019年第4期175-180,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的通过彩色多普勒血流显像(CDFI)对颈部动脉夹层(CAD)进行诊断及随访检测,分析比较颈内动脉夹层(ICAD)与椎动脉夹层(VAD)狭窄程度、管腔再通的差异性。方法回顾性连续纳入2014年1月至2018年12月于首都医科大学宣武医院经CDFI诊断并经高分辨率MRI和(或) CT血管成像证实的壁内血肿型CAD患者136例(160支夹层血管),并分为ICAD组(66例,75支)与VAD组(70例,85支),比较两组患者的性别、年龄及危险因素、脑缺血症状及CDFI表现等;发病后3、6、12个月随访,对CAD患者进行CDFI复查,并比较两组患者病变血管管腔再通率的差异。结果 ICAD组与VAD组患者平均年龄及高血压病所占比例差异有统计学意义(均P <0. 05)。两组患者病变血管的病变侧别差异无统计学意义(P> 0. 05);病变血管狭窄程度差异有统计学意义(P <0. 01),ICAD组狭窄程度≥70%或闭塞血管较VAD组明显增多[分别为88. 0%(66/75)、48. 2%(41/85)]。136例患者中,随访结束时,共随访复查105例126支病变血管,其中ICAD 58支,VAD 68支。发病后3、6个月随访时,VAD组病变血管管腔完全再通率明显高于ICAD组[分别为46. 6%(27/58)比21. 7%(10/46),58. 7%(37/63)比37. 3%(19/51)],差异均有统计学意义(χ~2值分别为6. 891、5. 201,P值分别为0. 009、0. 023);发病后12个月随访时,VAD组与ICAD组病变血管完全再通率[60. 3%(41/68)比53. 4%(31/58)]及不全再通血管中管腔残余狭窄程度差异均无统计学意义(χ~2值分别为0. 599、0. 297,均P> 0. 05)。结论 ICAD与VAD在管腔狭窄程度及不同随访时间的管腔再通率等方面具有差异性,CDFI对CAD具有良好的检测及随访复查价值。Objectives To diagnose and test cervical artery dissection (CAD) during the follow-up by color Doppler flow imaging (CDFI) and to analyze and compare the differences of internal carotid artery dissection (ICAD) and stenosis degree of vertebral artery dissection (VAD),and lumen recanalization. Methods From January 2016 to December 2018,a total of 136 consecutive patients (160 dissecting vessels) with CAD of intramural hematoma type diagnosed by CDFI and confirmed by high-resolution MRI and/or CT angiography in Xuanwu Hospital,Capital Medical University were enrolled retrospectively.They were divided into ICAD group (n=66,with 75 ICADs) and VAD group (n=70,with 85 VADs).The gender ,age,risk factors,cerebral ischemic symptoms,and CDFI manifestations were compared in the patients between the two groups.They were followed up at 3,6,and 12 months after onset.The patients with CAD were reexamined,and the difference of recanalization rate between the two groups was compared.Results There was a statistically significant difference in the mean age and proportion of hypertension between the ICAD group and the VAD group (both P <0.05).There was no significant difference in the side of lesion between two groups of patients with vascular lesions ( P >0.05);there was significant difference in the degree of vascular stenosis ( P <0.01).The degree of stenosis in the ICAD group was ≥70% or the number of occluded vessels was significantly higher than that in the VAD group (88.0%[66/75] and 48.2%[41/85],respectively).Of the 136 patients,at the end of follow- up,a total of 105 patients with 126 lesion vessels were followed up,including 58 ICADs and 68 VADs.At the follow-up of 3 months and 6 months after onset,the complete recanalization rate of the lesion vessels in the VAD group was significantly higher than that in the ICAD group (46.6%[27/58] vs .21.7%[10/46],and 58.7%[37/63] vs .37.3%[19/ 51]respectively),the difference was statistically significant (χ^2 values were 6.891 and 5.201 respectively,P values were 0.009 and 0.023 re

关 键 词：彩色多普勒血流成像 颈内动脉夹层 椎动脉夹层 随访 管腔再通 

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]