单侧颈内动脉系统血管狭窄或闭塞时的灌注核磁表现及其在介入治疗中的应用

发布时间：2018-02-12 20:44

本文关键词： 灌注损伤半球颈动脉狭窄颅内动脉狭窄支架治疗药物规范治疗　出处：《中国人民解放军医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的分析单侧颈内动脉系统血管狭窄或闭塞后的灌注核磁表现，探讨灌注核磁表现在缺血性脑血管病介入诊疗中的应用。资料与方法 1．在我院神经内科住院患者中选取符合条件的病例；入选标准为：1周内有颈内动脉系统缺血事件发生，包括脑梗死（CI)及短暂性脑缺血发作(TIA)；通过DSA证实病灶侧颈内动脉或大脑中动脉狭窄或闭塞,对侧颈内动脉系统无严重狭窄；核磁共振灌注影像存在相对应的灌注缺损。 2．采集入选患者的一般临床资料； 3．利用磁共振灌注成像技术（PWI)采集入选患者双侧大脑半球分水岭区的灌注参数：局部脑血流量(rCBF)，局部脑血容量（rCBV），平均通过时间（MTT），达峰时间(TTP)。具体采集方法见后。根据灌注损伤的严重程度分为4期，作为PWI基线资料。 4.通过数字减影血管造影(DSA)对入组患者进行血管评估，包括狭窄或闭塞部位，代偿途径，TICI分级等，与PWI基线资料进行相关性研究。 5.经DSA证实为症状性颈内动脉颅外段严重狭窄的患者，予以支架治疗，，并在术后72小时复查PWI；对症状性颈内动脉系统颅内段狭窄的患者予以药物规范治疗1周，如临床症状缓解，继续药物治疗，3个月后复查PWI；不能缓解者，予以颅内动脉支架治疗，术后72小时复查PWI；对动脉闭塞，或因其他原因不能行介入治疗的患者，予以药物规范治疗，3月后复查PWI。所有复查PWI均与基线PWI进行对比。结果 1．33例患者入组，其中男性23例，女性10例；年龄34-80（56.1±13.3）岁；短暂性脑缺血发作7例，新发脑梗死26例。 2.根据DSA结果以眼动脉及后交通动脉发出点为界，将颈内动脉系统血管分为三段：颈内动脉起始至眼动脉发出点为第一段，共12例，其中狭窄9例，闭塞3例；眼动脉发出点至后交通动脉发出点为第二段，共3例，其中狭窄1例，闭塞2例；后交通动脉发出点至大脑中动脉主干为第三段，共18例，其中狭窄8例，闭塞10例；无侧支循环代偿3例，以一级代偿为主5例，二级代偿为主24例，三级代偿为主1例。TICI分级一级5例，二级23例，三级5例。 3.PWI基线损伤1期7例，2期17例，3期5例，4期4例。 4.8例颈内动脉颅外段狭窄、1例大脑中动脉狭窄患者行介入支架治疗；并于术后72小时复查PWI，结果均为正常。 5．24例规范药物治疗患者，于3月后复查PWI，与基线数值比较11例改善，13例未变化。 6．9例未经介入治疗的颅内动脉狭窄患者经规范药物治疗3个月，1例病变血管闭塞。 7．33例患者3个月内临床症状无加重。结论 1．PWI在评价单侧颈内动脉系统缺血引起灌注损伤方面具有明确作用； 2．单侧颈内动脉系统动脉狭窄或闭塞后的灌注损伤程度与患者的年龄及TICI分级具有相关性； 3．介入支架治疗可迅速且显著的改善脑灌注损伤； 4．药物规范治疗在发生缺血事件3个月内可有效控制灌注损伤加重；但不能阻止部分动脉狭窄程度加重。
[Abstract]:objective
To investigate the application of NMR imaging in the interventional diagnosis and treatment of ischemic cerebrovascular disease by analyzing the perfusion MRI findings of the unilateral internal carotid artery stenosis or occlusion.
Information and methods
1. in our hospital were selected in accordance with the conditions of the patient; inclusion criteria: 1 weeks of internal carotid artery system ischemic events, including cerebral infarction (CI) and transient ischemic attack (TIA); the DSA confirmed that the ipsilateral internal carotid artery or middle cerebral artery stenosis or occlusion of contralateral carotid no severe artery stenosis; magnetic resonance perfusion imaging has corresponding perfusion defect.
2. the general clinical data of the selected patients were collected.
3. the use of magnetic resonance perfusion imaging (PWI) perfusion parameters collecting selected patients with bilateral cerebral watershed: regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), mean transit time (MTT), time to peak (TTP). After the specific acquisition method. According to the severity of reperfusion injury 4, PWI as the baseline data.
4. through digital subtraction angiography (DSA), we performed vascular assessment for patients, including stenosis or occlusion, compensatory pathways, TICI grading, and so on, and were correlated with PWI baseline data.
5. confirmed by DSA for symptomatic extracranial internal carotid artery stenosis patients to stent, and in 72 hours after the operation was PWI; for symptomatic carotid artery stenosis in patients with intracranial system to drug treatment for 1 weeks, such as clinical symptoms, to drug treatment, after 3 months of PWI; can not be remission, intracranial artery stent, 72 hours after the operation was PWI; for arterial occlusion, or interventional treatment of patients can not be for other reasons, to drug treatment, after the March review of PWI. PWI and PWI were all baseline were compared.
Result
1.33 patients were enrolled in the group, including 23 males and 10 females, 34-80 (56.1 + 13.3) years of age, 7 transient ischemic attacks and 26 new cerebral infarction.
2. according to the results of DSA in ophthalmic artery and posterior communicating artery a point for the community, the internal carotid artery blood vessel is divided into three sections: the internal carotid artery and ophthalmic artery from point of the first paragraph, a total of 12 cases, the stenosis in 9 cases, 3 cases of ophthalmic artery occlusion; a point to point out the posterior communicating artery is divided into second sections among them, a total of 3 cases, 1 cases of stenosis, 2 cases of posterior communicating artery occlusion; a main artery to the brain is divided into third sections, a total of 18 cases, the stenosis in 8 cases, 10 cases of occlusion; no collateral circulation in 3 cases, with a compensatory mainly in 5 cases, 24 cases of grade two compensation, three for 1 cases of.TICI grade compensatory grade a grade 5 cases, 23 cases of grade two, grade three in 5 cases.
3.PWI baselines were damaged in 1 stages, 7 cases, 2 stage 17 cases, 3 stage 5 cases, 4 stage 4 cases.
4.8 cases of internal carotid artery stenosis, 1 cases of middle cerebral artery stenosis were treated with interventional stent, and PWI was rechecked 72 hours after operation. The results were all normal.
5.24 patients with standardized drug treatment were reexamined after March. Compared with the baseline values, 11 cases were improved and 13 cases were not changed.
6.9 cases of intracranial artery stenosis without interventional therapy were treated by standardized medication for 3 months, and 1 cases of vascular occlusion.
In 7.33 patients, the clinical symptoms were not aggravated within 3 months.
conclusion
1.PWI has a clear role in evaluating ischemia-reperfusion injury in unilateral internal carotid artery system.
2. the degree of perfusion injury after the stenosis or occlusion of the unilateral internal carotid artery system was correlated with the age and TICI classification of the patients.
3. interventional stent therapy can quickly and significantly improve cerebral perfusion injury.
4. medication can effectively control the aggravation of perfusion injury within 3 months of the occurrence of ischemic events, but it can not prevent the aggravation of the degree of partial artery stenosis.

【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

【参考文献】