经颅多普勒超声联合经颅彩色多普勒超声评价基底动脉狭窄支架置入疗效及再狭窄因素的分析
发布时间：2018-11-21 17:39
【摘要】：目的联合应用经颅多普勒超声(TCD)及经颅彩色多普勒超声(TCCS)评估基底动脉狭窄支架置入前后血流动力学变化与术后再狭窄发生率及其危险因素。方法回顾性连续收集2013年6月至2015年6月首都医科大学宣武医院神经内、外科重度症状性基底动脉狭窄行支架置入术患者140例,均经TCCS检查及DSA证实。排除合并有颅外段椎动脉、颈动脉及锁骨下动脉重度狭窄影响基底动脉血流动力学评估及随访资料欠完整者,最终纳入62例。检查记录术前、术后1个月内及术后3、6、12个月基底动脉狭窄段、椎动脉颅内段、大脑后动脉(取较高侧测值)的收缩期峰值流速(PSV)、舒张期末流速(EDV)、平均流速(MFV)与血管搏动指数(PI)。比较术前、术后血流动力学参数变化,分析再狭窄发生率及其影响因素。结果 (1)62例患者支架置入术后1个月内基底动脉PSV、EDV、MFV均较术前明显下降[(119±50)cm/s比(232±54)cm/s、(52±26)cm/s比(124±40)cm/s、(74±33)cm/s比(160±43)cm/s,均P0.01],椎动脉颅内段PSV、EDV、MFV较术前明显升高[(65±15)cm/s比(50±18)cm/s、(28±8)cm/s比(22±8)cm/s、(40±10)cm/s比(31±11)cm/s,均P0.01];54例后交通动脉未开放的大脑后动脉PSV、EDV、MFV及PI均较术前升高[(69±14)cm/s比(53±16)cm/s、(30±7)cm/s比(27±8)cm/s、(43±9)cm/s比(36±10)cm/s、(0.92±0.10)比(0.70±0.13),均P0.01]。(2)62例患者3、6、12个月累积再狭窄发生率分别为14.5%(9/62)、19.4%(12/62)、28.1%(16/49,失访13例);应用自膨式支架和球囊扩张支架者12个月累积再狭窄发生率分别为22.2%(8/28,失访8例)和35.3%(8/21,失访5例),差异无统计学意义(χ2=0.335,P=0.563)。(3)COX回归分析结果显示,术后残余狭窄、长段狭窄(10 mm)是发生再狭窄的独立危险因素(HR:5.989,95%CI:1.887~19.006,P=0.002;HR:5.079,95%CI:1.277~20.200,P=0.021)。结论通过TCD联合TCCS检测后循环各段动脉PSV、EDV、MFV的变化可客观评估基底动脉支架置入的疗效,是及时发现基底动脉支架置入术后再狭窄的重要筛查手段。基底动脉支架置入术后再狭窄发生率较高,术后残余狭窄、长段狭窄是再狭窄发生的独立危险因素。
[Abstract]:Objective to evaluate the changes of hemodynamics and the incidence of restenosis and its risk factors before and after stent placement in basilar artery stenosis by transcranial Doppler (TCD) and transcranial color Doppler (TCCS). Methods 140 patients with severe symptomatic basilar artery stenosis underwent stenting in Xuanwu Hospital of Capital Medical University from June 2013 to June 2015. All patients were confirmed by TCCS and DSA. Exclusion of complicated with extracranial vertebral artery, severe stenosis of carotid artery and subclavian artery affecting hemodynamic evaluation of basilar artery and incomplete follow-up data were included in 62 cases. The peak systolic velocities of (PSV), end diastolic velocity (EDV),) were recorded before operation, 1 month after operation and 3 weeks after operation, 12 months after operation, intracranial segment of vertebral artery and posterior cerebral artery (taking higher side measurements). Mean Velocity (MFV) and Pulsatile Index (PI). The changes of hemodynamic parameters before and after operation were compared and the incidence of restenosis and its influencing factors were analyzed. Results (1) the PSV,EDV,MFV of basilar artery decreased significantly in 62 patients within 1 month after stent implantation [(119 卤50) cm/s vs (232 卤54) cm/s, vs (52 卤26) cm/s vs (124 卤40) cm/s,]. (74 卤33) cm/s vs (160 卤43) cm/s, and intracranial segment PSV,EDV,MFV of vertebral artery were significantly higher than those before operation [(65 卤15) cm/s vs (50 卤18) cm/s, (28 卤8) cm/s vs (22 卤8) cm/s,]. The ratio of (40 卤10) cm/s to (31 卤11) cm/s, was (P0.01). The PSV,EDV,MFV and PI of posterior cerebral artery in 54 patients with closed posterior communicating artery were higher than those before operation [(69 卤14) cm/s vs (53 卤16) cm/s, (30 卤7) cm/s vs (27 卤8) cm/s, (43 卤9) cm/s vs (36 卤10) cm/s,]. (0. 92 卤0. 10) vs (0. 70 卤0. 13), all P 0.01]. (2) the incidence of cumulative restenosis in 62 patients was 14. 5% (9 / 62), 19. 4% (12 / 62), 28. 1% (16 / 49), respectively. (13 cases); The incidence of cumulative restenosis in patients with self-expandable stent and balloon dilated stents was 22.2% (8 / 28, 8 / 8) and 35.3% (8 / 21, 5 cases), respectively. There was no significant difference (蠂 ~ 2 = 0.335). The results of COX regression analysis showed that residual stenosis and long segment stenosis (10 mm) were independent risk factors for restenosis (HR:5.989,95%CI:1.887~19.006,P=0.002;). HR:5.079,95%CI:1.277~20.200,P=0.021) Conclusion the changes of arterial PSV,EDV,MFV in each segment of circulation can be objectively evaluated by TCD combined with TCCS, and it is an important screening method to detect restenosis in time. The incidence of restenosis was higher after stent implantation. Residual stenosis and long segment stenosis were independent risk factors 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
本文编号：2347739
[Abstract]:Objective to evaluate the changes of hemodynamics and the incidence of restenosis and its risk factors before and after stent placement in basilar artery stenosis by transcranial Doppler (TCD) and transcranial color Doppler (TCCS). Methods 140 patients with severe symptomatic basilar artery stenosis underwent stenting in Xuanwu Hospital of Capital Medical University from June 2013 to June 2015. All patients were confirmed by TCCS and DSA. Exclusion of complicated with extracranial vertebral artery, severe stenosis of carotid artery and subclavian artery affecting hemodynamic evaluation of basilar artery and incomplete follow-up data were included in 62 cases. The peak systolic velocities of (PSV), end diastolic velocity (EDV),) were recorded before operation, 1 month after operation and 3 weeks after operation, 12 months after operation, intracranial segment of vertebral artery and posterior cerebral artery (taking higher side measurements). Mean Velocity (MFV) and Pulsatile Index (PI). The changes of hemodynamic parameters before and after operation were compared and the incidence of restenosis and its influencing factors were analyzed. Results (1) the PSV,EDV,MFV of basilar artery decreased significantly in 62 patients within 1 month after stent implantation [(119 卤50) cm/s vs (232 卤54) cm/s, vs (52 卤26) cm/s vs (124 卤40) cm/s,]. (74 卤33) cm/s vs (160 卤43) cm/s, and intracranial segment PSV,EDV,MFV of vertebral artery were significantly higher than those before operation [(65 卤15) cm/s vs (50 卤18) cm/s, (28 卤8) cm/s vs (22 卤8) cm/s,]. The ratio of (40 卤10) cm/s to (31 卤11) cm/s, was (P0.01). The PSV,EDV,MFV and PI of posterior cerebral artery in 54 patients with closed posterior communicating artery were higher than those before operation [(69 卤14) cm/s vs (53 卤16) cm/s, (30 卤7) cm/s vs (27 卤8) cm/s, (43 卤9) cm/s vs (36 卤10) cm/s,]. (0. 92 卤0. 10) vs (0. 70 卤0. 13), all P 0.01]. (2) the incidence of cumulative restenosis in 62 patients was 14. 5% (9 / 62), 19. 4% (12 / 62), 28. 1% (16 / 49), respectively. (13 cases); The incidence of cumulative restenosis in patients with self-expandable stent and balloon dilated stents was 22.2% (8 / 28, 8 / 8) and 35.3% (8 / 21, 5 cases), respectively. There was no significant difference (蠂 ~ 2 = 0.335). The results of COX regression analysis showed that residual stenosis and long segment stenosis (10 mm) were independent risk factors for restenosis (HR:5.989,95%CI:1.887~19.006,P=0.002;). HR:5.079,95%CI:1.277~20.200,P=0.021) Conclusion the changes of arterial PSV,EDV,MFV in each segment of circulation can be objectively evaluated by TCD combined with TCCS, and it is an important screening method to detect restenosis in time. The incidence of restenosis was higher after stent implantation. Residual stenosis and long segment stenosis were independent risk factors 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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