DSA三维旋转技术在椎动脉开口处狭窄介入治疗中应用价值  

Application value of DSA three-dimensional rotation technique in interventional treatment of vertebral artery ostial stenosis

作　　者：马向宏 阎世鑫[1] MA Xiang-hong;YAN Shi-xin(Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津市环湖医院,天津300350

出　　处：《生物医学工程与临床》2024年第6期805-810,共6页Biomedical Engineering and Clinical Medicine

摘　　要：目的探讨数字减影血管造影(DSA)三维(3D)旋转血管造影(3DRA)技术在椎动脉开口处狭窄介入治疗中的应用价值。方法选择缺血性脑卒中椎动脉开口处狭窄患者70例,其中男性65例,女性5例;年龄45~82岁,中位年龄67岁;体质量48.9~88.7 kg,平均体质量74.87 kg;高血压50例,高脂血症36例。所有患者在手术前均行椎动脉超声、CT血管造影(CTA)检查,以及DSA介入检查并行术中3DRA检查;将3DRA原始数据传输至西门子Artis zeeⅢbiplane DSA 3D后处理工作站,应用彩色容积重组技术对图像进行后处理,将3DRA像与3D后处理彩色容积图像相结合观察,对椎动脉开口处狭窄病变进行分析与评估。为医师进行下一步的手术,即在椎动脉开口处置入支架,提供最佳角度,帮助引导手术入路。对4种不同检查方法[椎动脉超声、CTA、二维(2D)-DSA、3DRA]诊断结果进行统计学分析。结果70例椎动脉开口处狭窄患者(81支血管)中,椎动脉开口处重度狭窄54支(其中3例为双侧椎动脉开口处重度狭窄;6例为一侧椎动脉开口处重度狭窄,另一侧椎动脉开口处中度狭窄),中度狭窄20支(其中1例为双侧椎动脉开口处中度狭窄),轻度狭窄7支(其中1例患者为一侧椎动脉开口处轻度狭窄,另一侧椎动脉开口处重度狭窄)。所有患者均通过3DRA技术对病变进行明确诊断,并指导手术入路,顺利置入椎动脉开口支架43枚。与3DRA比较,椎动脉超声对狭窄程度的诊断4例高估、8例低估;CTA对狭窄程度诊断为3例高估、1例低估;2D-DSA对狭窄程度的诊断为仅为1例高估、1例低估。2D-DSA、3DRA、CTA及椎动脉超声对椎动脉开口处狭窄诊断准确度及差异性比较,差异有统计学意义(P<0.05)。对中、重度狭窄的病例,3DRA与2D-DSA对狭窄形态学显示的灵敏度比较,检出率差异有统计学意义(P<0.05)。结论3DRA与2D-DSA诊断椎动脉开口处狭窄准确度高于CTA与椎动脉超声。3DRA技术对椎动脉Objective To explore the application value of digital subtraction angiography(DSA)three-dimensional rotational angiography(3DRA)in interventional treatment of vertebral artery ostial stenosis.Methods A total of 70 patients with vertebral artery ostial stenosis in ischemic stroke were enrolled,which included 65 males and 5 females,aged 45-82 years old with median age of 67 years old;body mass 48.9-88.7 kg with mean body mass of 74.87 kg;50 cases of hypertension and 36 of hyperlipidemia.All of them performed vertebral artery ultrasound,CTA examination,DSA interventional examination and intraoperative 3DRA examination before operation.The 3DRA raw data were transmitted to Siemens Artis zeeⅢbiplane DSA 3D post-processing workstation,and the image was post-processed by color volume reconstruction technique.The 3DRA image was combined with 3D post-processing color volume image to analyze and evaluate vertebral artery ostial stenosis,which provided the best angle for surgery(stent placement at vertebral artery ostial),and help surgeon to guide surgical approach.The diagnostic results of 4 different examination methods[vertebral artery ultrasound,CTA,two-dimensional(2D)-DSA,3DRA]were statistically analyzed.Results Among 70 patients(81 blood vessels)with vertebral artery ostial stenosis,54 were severe stenosis(3 cases were bilateral;6 cases of unilateral,moderate stenosis on the other side),20 cases of moderate stenosis(1 case of bilateral),and 7 cases of mild stenosis(1 case of unilateral,severe stenosis on the other side).All patients were diagnosed by 3DRA technology and surgical approach was guided,and 43 vertebral artery ostial stents were successfully implanted.Compared with 3DRA,vertebral artery ultrasound overestimated the stenosis degree in 4 cases and underestimated in 8 cases;CTA overestimated stenosis degree in 3 cases and underestimated in 1 case,and stenosis degree was only overestimated in 1 case and underestimated in 1 case by 2D-DSA.The diagnostic accuracy and difference of 2D-DSA,3DRA,CTA and vertebral

关 键 词：缺血性脑卒中 椎动脉 开口处狭窄 椎动脉开口处支架置入术 三维旋转血管造影技术 

分 类 号：R816.1[医药卫生—放射医学]