血管内超声在颈动脉支架成形术中应用的初步研究

发布时间：2018-06-23 16:39

  本文选题：颈动脉狭窄 + 支架成形术　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:利用血管内超声(IntravascularUltrasound,IVUS)对颈动脉粥样硬化斑块进行定性、定量分析,并指导和评价颈动脉支架置入的效果,探讨血管内超声在颈动脉狭窄诊治中的应用意义。方法:采用前瞻性病例对照研究,纳入2014年7月至2016年4月于我院神经内科住院的患者12例,通过全脑数字减影血管造影(Digital Subtraction Angiography,DSA)检查确诊为颈动脉中度或重度狭窄,并获取影像学资料,测得颈动脉狭窄最严重处斑块总数、偏心性斑块数目以及管腔最窄处的直径、病变血管近远端正常血管直径;对符合颈动脉支架成形术适应症的患者,于支架前行IVUS检查,观察颈动脉狭窄处管腔及血管壁情况,测得狭窄最严重处斑块总数、偏心性斑块数目以及管腔最窄处血管横截面的总面积及管腔面积。支架置入后行DSA和IVUS检查,复测支架置入后最窄处管腔的直径、管腔最窄处血管横截面的总面积及管腔面积,并观察支架后展开及贴壁情况,评价支架置入的效果,对两组检查方法所得出的结果进行对比分析。结果:12例患者的IVUS灰阶图像显示:颈总动脉呈单层结构,颈内动脉均为三层结构,颈动脉狭窄最严重处斑块性质分别是:纤维斑块5处,纤维脂质斑块2处,钙化、混合斑块分别为3处、2处。病变血管中DSA观察到偏心性病变占23.5%,IVUS观察到偏心病变占为56.5%,两种检查方法比较有显著统计学差异(P0.05)。支架置入术前DSA测得直径狭窄率为(66.08±5.84)%,IVUS测得面积狭窄率为(86.92±6.26)%,两者有显著统计学差异(P0.01);支架置入术后DSA测得直径狭窄率为(12.75±4.88)%,IVUS测得面积狭窄率为(19.25±5.31)%,两者也有显著统计学差异(P0.01)。12例患者颈动脉支架置入均获得成功,术中及围手术期无并发症产生。术中7例支架后DSA提示残余狭窄30%,其IVUS均显示展开不良,它们存在贴壁不好,其中4例有支架对称性不好,予以球囊扩张后,IVUS均显示病变段血管得到充分扩张、支架对称性与贴壁良好,其它5例残余狭窄30%的患者支架后IVUS检查均存在不同程度的贴壁欠佳的现象,无对称不良者。结论:IVUS能较为准确的判定粥样硬化斑块的性质,对病变部位的狭窄程度的判定较DSA更精确,对支架置入的即时效果评价较DSA更准确,可指导血管内介入治疗。
[Abstract]:Objective: to evaluate the value of intravascular ultrasound (IVUS) in the diagnosis and treatment of carotid artery stenosis by using intravascular ultrasound (IVUS) for qualitative and quantitative analysis of carotid atherosclerotic plaque, and to guide and evaluate the effect of carotid stent implantation. Methods: a prospective case-control study was conducted in 12 patients admitted to the Department of Neurology from July 2014 to April 2016. The carotid artery stenosis was diagnosed by digital subtraction angiography (DSA). Imaging data were obtained to determine the total number of plaques in the most severe carotid stenosis, the number of eccentric plaques and the diameter of the narrowest part of the lumen, and the diameter of the proximal and distal normal vessels of the diseased vessels. Before stenting, IVUS was performed to observe the lumen and wall of carotid artery stenosis. The total number of plaques, the number of eccentric plaques and the total area and lumen area of the vessel cross section at the narrowest part of the lumen were measured. After stent placement, DSA and IVUS were performed. The diameter of the narrowest lumen, the total area and the lumen area of the narrowest vessel in the stent were measured, and the expansion and adhesion of the stent were observed to evaluate the effect of stent placement. The results of the two groups were compared and analyzed. Results the gray-scale IVUS images of 12 patients showed that the common carotid artery was monolayer, and the internal carotid artery had a three-layer structure. The most severe carotid artery stenosis was found in 5 fibrous plaques, 2 fibrous lipid plaques, and calcification. The mixed plaques were 3 sites and 2 sites respectively. The percentage of eccentric lesions observed by DSA and IVUS was 56.5, and there was significant difference between the two methods (P0.05). The diameter stenosis rate measured by DSA before stent implantation was (66.08 卤5.84) and the area stenosis rate measured by IVUS was (86.92 卤6.26), there was significant difference between the two groups (P0.01), the diameter stenosis rate measured by DSA after stent implantation was (12.75 卤4.88) and the area stenosis rate measured by IVUS was (19.25 卤5.31). The carotid stents were successfully implanted in 12 patients (P0.01). No complications occurred during and around the operation. In 7 cases, DSA showed residual stenosis 30%, IVUS was not well developed, and there was poor adherence to the stent in 4 cases. After balloon dilatation, IVUS showed that the lesion vessels were fully dilated. The symmetry and adhesion of stents were good. IVUS examination of other 5 patients with 30% residual stenosis had different degree of poor adherence to the stents, but not symmetrical ones. ConclusionVIVUS is more accurate in judging the nature of atherosclerotic plaque, and more accurate in judging the degree of stenosis of lesion than DSA. The immediate evaluation of stent implantation is more accurate than that of DSA, and it can be used as a guide for intravascular interventional therapy.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
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本文编号：2057726