症状性颈动脉重度狭窄患者支架术后高灌注脑出血的风险评估

发布时间：2018-04-02 14:15

本文选题：颈动脉疾病　切入点：支架置入术　出处：《中国脑血管病杂志》2017年11期

【摘要】：目的评估症状性颈动脉重度狭窄患者颈动脉支架置入术(CAS)后高灌注脑出血(HICH)发生的风险。方法回顾性分析第二军医大学附属长海医院神经外科2009年6月至2015年6月接受CAS治疗的210例症状性颈动脉重度狭窄(狭窄率70%~99%)患者的临床资料,其中7例(3.3%)术后发生了HICH。评估患者临床基线、影像学特点与HICH之间的关系。患者术前均接受脑CT灌注检查评估,定义脑血流量达峰时间(TTP)指数为患侧与对侧TTP的比值。计量资料的比较采用t检验,计数资料的比较采用Poisson检验。结果 HICH组和无HICH组TTP指数的差异有统计学意义(1.15±0.10比1.30±0.15,t=4.461,P0.01)。ROC曲线分析结果提示,TTP指数1.22可作为预测HICH的危险因子(敏感度为100%,特异度为75.9%)。结论颈内动脉重度狭窄患者,若术前TTP指数1.22,提示在CAS后发生HICH的风险较高。
[Abstract]:Objective to evaluate the risk of hyperperfusion intracerebral hemorrhage (HICH) after carotid stenting in patients with severe symptomatic carotid stenosis.Methods the clinical data of 210 patients with severe symptomatic carotid stenosis (70 / 99) treated with CAS from June 2009 to June 2015 in the Department of Neurosurgery of Changhai Hospital affiliated to the second military Medical University were retrospectively analyzed. Among them, 7 cases had HICH after operation.To evaluate the relationship between clinical baseline, imaging features and HICH.All patients were assessed with cerebral CT perfusion before operation, and the TTP index was defined as the ratio of the affected side to the contralateral TTP.T test was used to compare measurement data and Poisson test was used to compare counting data.Results the difference of TTP index between HICH group and no HICH group was statistically significant (1.15 卤0.10 vs 1.30 卤0.15). The results showed that 1.22 could be used as a risk factor for predicting HICH (sensitivity was 100 and specificity was 75.9).Conclusion the preoperative TTP index of 1.22 in patients with severe stenosis of internal carotid artery suggests a higher risk of HICH after CAS.
【作者单位】：第二军医大学附属长海医院神经外科;
【基金】：国家自然科学基金(81501008)
【分类号】：R743.34

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