超声造影在评价支架植入术治疗颅外段颈动脉狭窄中的应用价值

目的 评价超声造影（contrast-enhanced ultrasound,CEUS）在支架植入术（carotid artery angioplasty and stent,CAAS）治疗颅外段颈动脉狭窄中的应用价值.方法 对26例颅外段颈动脉狭窄患者,在CAAS手术前后分别进行CEUS和数字减影血管造影（digital subtraction angiography,DSA）检查,计算颈动脉狭窄率和血管内径.分别对CEUS和DSA的检测结果进行狭窄分级,Kappa检验评价两种方法的检测一致性.结果 CEUS检测显示颈动脉平均狭窄率从术前（83.12±16.23）%降至术后（15.32±8.51）%,差异有统计学意义（t=18.86,P＜0.01）;DSA检测显示颈动脉平均狭窄率从术前（81.32±13.63）%降至术后（13.11±6.72）%,差异有统计学意义（t=18.86,P＜0.01）.血管内径从术前（1.51±0.61）mm提高至术后（4.36±0.55）mm,差异有统计学意义（t=-17.69,P＜0.01）.24处颈内动脉起始段及15处颈动脉分叉段狭窄CEUS和DSA检测狭窄分级一致性均较好（Kappa=0.753、0.779,P＜0.01）.结论 CEUS可作为颅外段颈动脉狭窄筛查、术前评估、术后随访的检查方法,对不便接受DSA检查的患者能基本替代DSA检查.

Clinical significance of contrast-enhanced ultrasound in the treatment of carotid artery stenosis with stent implantation

Objective To investigate the clinical significance of contrast-enhanced ultrasound （CEUS） in the treatment of carotid artery stenosis with carotid artery angioplasty with stenting（CAAS）. Methods Before and after treatment with CAAS,26 patients with extracranial carotid stenosis were examined by DSA CEUS and digital subtraction angiography （DSA）. Stenosis rates and vessel diameter based on CEUS and DSA were calculated and compared by t-test. The assessment of CEUS and DSA in the treatment of carotid artery stenosis with CAAS was performed by kappa test. Results There was a significant difference between stenosis rates calculated by CEUS before CAAS（83.12 ± 16.23%） and after CAAS（15.32 ±8.51%） （t= 18.86,P 〈 0.01 ）. There was a significant difference between stenosis rates calculated by DSA before CAAS （81.32 ±13.63%） and after CAAS （13.11 ±6.72%） （t=18.86,P〈 0.01）. There was a significant difference between vessel diameters before CAAS （1.51 ±0.61mm） and after CAAS（4.36 ±0.55mm） （t- 17.69,P 〈 0.01）.The kappa test showed that not only in 24 stenosis on proximal segment but also in 15 stenosis on dividing segment,the CEUS and DSA indicated very good consistency（Kappa 〉 0.75）. Conclusion CEUS is an appropriate method in examination of extracranial carotid artery stenosis, preoperative evaluation and postoperative follow-up.CEUS may be used instead of DSA in patients unable to achieve DSA examination.