血管超声对颅内段椎动脉重度狭窄支架置入前后的血流动力学评价

发布时间：2018-06-19 18:12

本文选题：颅内椎动脉 + 支架　；参考：《中国脑血管病杂志》2015年08期

【摘要】：目的探讨彩色多普勒血流显像(CDFI)和经颅彩色多普勒超声(TCCS)联合检测评价颅内段椎动脉(IVA)重度狭窄支架置入治疗前后及再狭窄的血流动力学变化及其临床价值。方法回顾性纳入2011年11月至2013年11月经CDFI和TCCS联合检测并行全脑DSA证实的IVA重度狭窄患者102例,比较支架治疗前、术后1周及术后3、6、12个月椎动脉颅内、颅外段收缩期峰值流速(PSV)、舒张期末流速(EDV)、IVA搏动指数(PI)及颅外段阻力指数(RI)、管径、频谱形态和血流动力学参数。根据随访12个月时TCCS结果,将患者进一步分为再狭窄组(16例)和无再狭窄组(86例)。结果 (1)TCCS检测显示,支架置入术后1周狭窄段的PSV、EDV、PI较术前明显改善,分别为(109±40)比(258±63)cm/s、(47±18)比(132±45)cm/s、0.91±0.15比0.75±0.18,差异均有统计学意义(均P0.01)。再狭窄组的PSV、EDV在术后3~12个月逐渐升高,术后12个月与术后1周比较,差异均有统计学意义(均P0.01);无再狭窄组的PSV、EDV在术后12个月与术后1周比较,差异无统计学意义(P0.05)。(2)CDFI检测显示,术后1周患侧颅外段的PSV、EDV较术前明显改善,分别为(6 4±1 5)cm/s比(5 1±1 5)cm/s、(24±6)cm/s比(19±7)cm/s(均P0.01),RI值和颅外段椎动脉管径逐渐改善,于术后12个月时达到最高[0.61±0.07比0.63±0.12,P=0.038;(3.6±0.4)mm比(3.4±0.5)mm,P=0.009]。结论 CDFI与TCCS的联合应用可以客观评价IVA支架置入术前、术后颅外段及颅内段的血流动力学变化,为支架置入的有效性和再狭窄的影像学评估提供参考信息。
[Abstract]:Objective to evaluate the clinical value of color Doppler flow imaging (CDFI) combined with transcranial color Doppler ultrasonography (TCCS) in evaluating the hemodynamic changes of patients with severe stenosis of intracranial vertebral artery (IVA) before and after treatment. Methods 102 patients with severe stenosis of IVA were examined by CDFI and TCCS from November 2011 to November 2013 and confirmed by whole-brain DSA. The peak systolic velocity of extracranial segment (PSV), the end diastolic velocity (EDV), the pulsatility index (Pi) of IVA, the resistance index of extracranial segment (RI), the diameter of the tube, the frequency spectrum and the parameters of hemodynamics. According to the TCCS results of 12 months follow-up, the patients were further divided into restenosis group (n = 16) and non-restenosis group (n = 86). Results the results of TCCS showed that the PSVV EDVV index in the stenosis segment was significantly improved 1 week after stenting, which was 109 卤40 vs 258 卤63 cm / s (47 卤18) vs 132 卤45 cm / s (0.91 卤0.15) vs 0.75 卤0.18, respectively (P 0.01). In restenosis group, PSV EDV increased gradually from 3 to 12 months after operation, and there was significant difference between 12 months after operation and 1 week after operation (all P 0.01), but there was no significant difference between 12 months after operation and 1 week after operation in no restenosis group. At 1 week postoperatively, the PSVV EDV in the extracranial segment of the affected side was significantly improved compared with that before the operation, which was 64 卤1 5)cm/s vs 51 卤1.5 cm 路s / s 24 卤6)cm/s vs 19 卤7 cm / s respectively (P 0.01) and the diameter of the extracranial vertebral artery gradually improved, reaching the highest level at 12 months after operation [0.61 卤0.07 vs 0.63 卤0.63 卤0.12 5)cm/s vs 3.4 卤0.5mm 路min ~ (-1) P 0.009]. Conclusion the combined use of CDFI and TCCS can objectively evaluate the hemodynamic changes of extracranial and intracranial segments before and after IVA stent implantation, and provide reference information for the efficacy of stent implantation and imaging evaluation of restenosis.
【作者单位】：首都医科大学宣武医院血管超声诊断科;
【分类号】：R743;R445.1

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