术前DSA检查与颈动脉内膜切除术后新发脑梗死特点及相关性分析  

Correlation between preoperative digital subtraction angiography and postoperative ischemic brain lesions in patients undergoing carotid endarterectomy

作　　者：孙欢 王健[1,3] 李龙[1] 杨斌[1] 谌燕飞[1] 王亚冰[1] 高鹏[1] 陈健[1] 马妍[1] 焦力群[1] Sun Huan;Wang Jian;Li Long;Yang Bin;Chen Yanfei;Wang Yabing;Gao Peng;Chen Jian;Ma Yan;Jiao Liqun(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]三峡大学附属仁和医院神经外科,443000 [3]南京医科大学附属常州市第二人民医院神经外科,213004

出　　处：《中国脑血管病杂志》2023年第7期458-463,481,共7页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的研究术前DSA检查与颈动脉内膜切除术(CEA)后新发脑梗死发生特点及发生风险的相关性。方法回顾性连续纳入2019年1—12月在首都医科大学宣武医院神经外科行CEA的颈动脉粥样硬化性狭窄患者236例,颈动脉粥样硬化性狭窄程度由CT血管成像(CTA)或DSA检查评估。所有患者分别于CEA术前7 d、术后3 d内行MR检查。根据术前影像学检查方式的不同,将所有颈动脉粥样硬化性狭窄患者分为CTA组和DSA组,对两组患者的基线资料、术后新发脑梗死MR特征进行组间比较;并进一步对CTA组和DSA组内术后新发脑梗死发生与否进行亚组分析。根据术后是否发生脑梗死,将所有颈动脉粥样硬化性狭窄患者分为新发脑梗死组与无新发脑梗死组,并比较两组的基线资料、手术相关临床资料。将术后有无新发脑梗死组单因素分析中P<0.05的相关变量纳入多因素Logistic回归分析,进一步分析术后新发脑梗死的影响因素。结果(1)236例颈动脉粥样硬化性狭窄患者中,CTA组163例(69.1%),DSA组73例(30.9%)。与CTA组比较,DSA组患者既往卒中史和多血管病变比例更高,CEA手术时间更长,组间差异均有统计学意义[45.2%(33/73)比26.4%(43/163),χ^(2)=9.722;82.2%(60/73)比52.1%(85/163),χ^(2)=8.511;(147±47)min比(127±54)min,t=19.526;均P<0.01]。CTA组与DSA组患者年龄、性别、基础疾病史、吸烟、饮酒、症状性颈动脉狭窄、前后交通开放、重度狭窄的差异均无统计学意义(均P>0.05)。(2)DSA组患者术后新发脑梗死、Ⅳ型脑梗死、梗死同侧、对侧、双侧发生率高于CTA组,组间差异均有统计学意义[45.2%(33/73)比11.7%(19/163),χ^(2)=6.723;41.1%(30/73)比7.4%(12/163),χ^(2)=38.219;24.7%(18/73)比10.4%(17/163),χ^(2)=8.081;11.0%(8/73)比0;9.6%(7/73)比1.2%(2/163),χ^(2)=7.467;均P<0.01]。(3)术后新发脑梗死发生率为22.0%(52/236)。颈动脉粥样硬化性狭窄患者CEA术后新发脑梗死单因素Logistic回归分析显�Objective To study the correlation between preoperative digital subtraction angiography(DSA)examination and cerebral infarction after carotid endarterectomy(CEA).Methods A total of 236 patients with carotid atherosclerotic stenosis who underwent CEA in the Department of Neurosurgery of Xuanwu Hospital,Capital Medical University from January to December 2019 were retrospectively included.The degree of carotid atherosclerotic stenosis was assessed by computer tomography angiography(CTA)or DSA examination.All patients underwent magnetic resonance(MR)examination 7 days before and 3 days after CEA.Patients were divided into CTA group and DSA group according to preoperative examination methods.The baseline data and MR characteristics of postoperative new cerebral infarction were compared between the two groups,subgroup analysis of whether postoperative new cerebral infarction in the CTA group and DSA group.All patients with carotid atherosclerotic stenosis were divided into new cerebral infarction group and no new cerebral infarction group according to whether cerebral infarction occurred after operation,and the baseline data and surgical related clinical data of the two groups were compared.The relevant variables with P<0.05 in the univariate analysis of the group with or without postoperative new cerebral infarction were included in the multivariate Logistic regression analysis to further analyze the influencing factors.Results(1)Among 236 patients included,there were 163 cases(69.1%)in the CTA group and 73 cases(30.9%)in the DSA group.The patients in the DSA group had a higher proportion of stroke history and multivascular disease,and the operation time of CEA was longer.There were significant differences between two groups(45.2%[33/73]vs.26.4%[43/163],χ^(2)=9.722;82.2%[60/73]vs.52.1%[85/163],χ^(2)=8.511;[147±47]min vs.[127±54]min,t=19.526;all P<0.01).There were no significant differences in age,gender,underlying disease history,smoking,drinking,symptomatic carotid artery stenosis,anterior and posterior communic

关 键 词：颈动脉内膜切除术 缺血性卒中 弥散加权成像 数字减影血管造影 颈动脉狭窄 

分 类 号：R651.12[医药卫生—外科学]