容积CT数字减影血管造影与CT血管造影评估后循环脑梗死患者椎动脉起始部支架置入术后再狭窄的效能  

Evaluation of Volumetric CT Digital Subtraction Angiography and CT Angiography on the Restenosis Efficacy of Stent Placement at Vertebral Artery Ostium

作　　者：杜军凯 张龄尹 DU Junkai;ZHANG Lingyin(Tangdu Hospital,Air Force Military Medical University,Xi'an Shaanxi 710038)

机构地区：[1]空军军医大学唐都医院放射诊断科,陕西西安710038 [2]陕西省宝鸡市人民医院医学影像科,陕西宝鸡721000

出　　处：《医学临床研究》2024年第12期1920-1923,共4页Journal of Clinical Research

摘　　要：【目的】探讨容积CT数字减影血管造影(VCTDSA)与CT血管造影(CTA)评估后循环脑梗死患者椎动脉起始部支架置入术后再狭窄的效能。【方法】前瞻性选取2020年1月至2022年7月空军军医大学唐都医院收治的82例行椎动脉起始部支架置入术的后循环脑梗死患者,以数字减影血管造影(DSA)检查为金标准,依次完成CTA、VCTDSA及DSA影像学检查,记录CTA、VCTDSA及DSA分别评估动脉狭窄发生率及狭窄动脉形态。采用Kappa诊断分析CTA、VCTDSA诊断动脉狭窄与DSA结果的一致性,以受试者工作特征(ROC)曲线评估其诊断价值。【结果】DSA检查结果显示,82例行椎动脉起始部支架置入术治疗的患者术后狭窄22例,动脉狭窄发生率为26.83%。CTA、VCTDSA术后动脉狭窄的Kappa值分别为0.766、0.936。CTA及VCTDSA诊断术后动脉狭窄的曲线下面积(AUC)分别为0.839、0.938。DSA检查结果显示,82例行椎动脉起始部支架置入术治疗的患者术后狭窄血管22条,狭窄动脉规则型血管14条,不规则型8条。CTA、VCTDSA诊断术后狭窄动脉形态的Kappa值分别为0.585、0.697。CTA及VCTDSA诊断术后狭窄动脉斑块形态结果的AUC分别为0.777、0.839。【结论】CTA及VCTDSA在后循环脑梗死患者椎动脉起始部支架置入术后再狭窄及血管形态诊断中效能均较高,且VCTDSA诊断效能相对更高。【Objective】To evaluate the efficacy of volumetric CT digital subtraction angiography(VCTDSA)and CT angiography(CTA)in the assessment of restenosis in patients with posterior circulating cerebral infarction after stent placement in the vertebral artery ostium.【Methods】From January 2020 to July 2022,82 patients with posterior circulation cerebral infarction who underwent vertebral artery initiation stenting were prospectively selected.Using DSA as the gold standard,CTA,VCTDSA and DSA imaging examinations were performed sequentially.CTA,VCTDSA and DSA were recorded to evaluate the incidence and morphology of arterial stenosis,respectively.Kappa test was used to analyze the consistency between the results of CTA and VCTDSA in detecting arterial stenosis and DSA,and the diagnostic value was evaluated by receiver operating characteristic(ROC)curve.【Results】DSA examination results showed that 22 of 82 patients who underwent vertebral artery initiation stenting had postoperative stenosis,and the stenosis incidence was 26.83%.The Kappa values of CTA,VCTDSA in diagnosing postoperative arterial stenosis were 0.766 and 0.936,respectively.The area under the curve(AUC)of CTA and VCTDSA were 0.839 and 0.938,respectively.DSA examination results showed that there were 22 stenosis vessels,14 regular stenosis vessels and 8 irregular stenosis vessels in 82 patients who underwent the treatment of vertebral artery initiation stenting.The Kappa values of stenosis artery morphology after diagnosis by CTA,VCTDSA were 0.585 and 0.697,respectively.The AUC of CTA and VCTDSA were 0.777 and 0.839,respectively.【Conclusion】Both CTA and VCTDSA have higher diagnostic efficacy in restenosis and vascular morphology after stenting at the beginning of vertebral artery,while VCTDSA is superior.

关 键 词：脑梗死 计算机体层摄影血管造影术 椎动脉 血管内操作 

分 类 号：R743.33[医药卫生—神经病学与精神病学]