磁共振弥散加权成像评价颈动脉支架成形术中应用保护伞后新发缺血性脑损害的评价

目的采用磁共振弥散加权成像（DWI）评价颈动脉支架成形术中应用保护伞后新发缺血性脑损害的情况。方法共纳入60例颈动脉狭窄（狭窄率为50％～95％）患者，均行颈动脉支架置入术，分为保护伞组（30例）和非保护伞组（30例）。手术前后24h内行DWI检查，计数术后新发脑缺血病灶的数量、大小和部位。结果①术后24h内行DWI检查，共18例患者出现高密度缺血病灶，其中保护伞组6例（20％），非保护伞组12例（40％），差异无统计学意义，P〉0．05。②共出现高密度缺血病灶41个，其中保护伞组14个，非保护伞组27个；病灶主要位于支架同侧，两组病灶部位构成比的比较，差异无统计学意义，P〉0．05。③直径≤3mm的病灶共33个，其中保护伞组13个，非保护伞组20个；直径〉3mm的病灶共8个，其中保护伞组1个，非保护伞组7个，两组病灶大小构成比的比较，差异无统计学意义，P〉0．05。结论颈动脉支架置入术中使用保护伞可减少新发缺血病灶的发生，尤其是直径较大的病灶，但术中仍可出现新发缺血病灶。

Evaluation of new ischemic brain damage after using protective filter device during carotid artery stenting with diffusion-weighted magnetic resonance imaging

Objective To evaluate new ischemic brain damage after using protective filter device during carotid artery stenting with diffusion-weighted magnetic resonance imaging （ DWI ）. Methods A total of 60 patients with carotid stenosis （ stenotic rate 50% - 95% ） were included in this study. They underwent carotid artery stenting and were divided into protective filter device group （n = 30 ） and none protective filter device group （ n = 30）. DWI was performed within 24 hours before and after the procedure. The number, size, and location of new cerebral ischemic lesions after the procedure were counted. Results （1）DWI was performed within 24 hours after the procedure. A total of 18 patients oceurred high-density isehemic cerebral lesions, six of them （20%） were in the protective filter device group and 12 （40%） were in the none protective filter device group. There was no significant difference （P 〉 0.05）. （2） A total of 41 new ischemic cerebral lesions were detected, 14 of them were in the protective filter device group and 27 were in the none protective filter device group. The lesions mMnly located in the same sides of stents. There was no significant difference in the constituent ratio of the lesion sites between two groups （ P 〉 0.05 ）. 3）There were 33 lesions of ≤3 mm diameter, 13 of them were in the protective filter device group and 20 were in the none protective filter device group. There were 8 lesions 〉 3 mm in diameter, one of them was in the protective filter device group and 7 were in the none protective filter device group. There was no significant difference in the constituent ratio of the lesion size between the two groups （P 〉 0.05 ）. Conclusion Using protective filter device during earotid artery stenting may deerease the occurrence of new isehemic cerebral lesions, especially large large sized lesions. However, new ischemic cerebral lesions may occur during the procedure.