经颅多普勒超声对大脑中动脉狭窄患者支架置入后的随访研究

目的通过经颅多普勒超声（TCD）评估大脑中动脉狭窄患者支架置入（MCAS）前、后的血流动力学变化及再狭窄的发生率，并分析其相关影响因素。方法前瞻性纳入2006年1月-2012年4月，因症状性大脑中动脉狭窄接受支架置入的患者共62例（62枚支架）。采用TCD检测支架置入术前、术后1周及3、6、12个月大脑中动脉狭窄段、狭窄远段和大脑前动脉、大脑后动脉的血流动力学参数，判断12个月时的再狭窄发生率。分析残余狭窄、支架类型及疾病危险因素对MCAS术后再狭窄的影响。结果①MCAS术前、术后1周MCA狭窄段的收缩期峰值流速（PSV）和平均流速（MFV）分别由（308±59）cm／s和（218±51）cm／s降至（159±54）cm／s和（102±39）cm／s，差异有统计学意义（P〈0．01）。@TCD术后1周残余狭窄的检出率为11．3％（7／62），术后1年的再狭窄发生率为19．4％（12／62）。③经多因素Logistic回归分析，糖尿病（P=0．024，OR=7．048，95％CI：1．286～38．617）和残余狭窄（P=0．040，OR=8．995，95％CI：1．110～72．911）是支架置人后再狭窄的独立危险因素。④是否规律服用降脂类药物的患者，MCAS再狭窄发生率差异有统计学意义7．4％（2／27）比36．4％（8／22），P=0．032]。结论TCD可以作为客观评估MCAS前、后血流动力学改变以及远期疗效观察的重要手段。糖尿病和术后残余狭窄是再狭窄发生的独立危险因素。术后规律性服用降脂类药物，可以降低MCAS再狭窄的发生率。

Follow-up study in patients with middle cerebral artery stenosis after stenting with transcranial

Objective To evaluate the hemodynamic changes and the incidence of restenosis before and after middle cerebral artery stenosis （MCAS） with trauscranial Doppler uhrasonography （TCD） and to analyze its related influencing factors. Methods A total of 62 patients （ 62 stents） who accepted stenting because of symptomatic MCAS were enrolled prospectively from January 2006 to April 2012. TCD was used to detect the hemodynamic parameters of the segment of MCAS, distal stenosis, anterior cerebral artery and posterior cerebral artery before procedure and at 1 week, 3, 6, and 12 months after procedure. The inci- dence of restenosis at 12 months was judged. The effects of residual stenosis, types of stents and disease risk factors on restenosis after MCAS procedure were analyzed. Results ①Before MCAS stenting and one week after procedure, the peak systolic velocity （PSV） and mean flow velocity （MFV） of the segment of MCAS decreased from 308 ± 59 cm/s and 218 ± 51 cm/s to 159 ± 54 cm/s and 102 ± 39 cm/s respective- ly. The difference was statistically significant （ P 〈 0.01 ）.②The detection rate of residual stenosis was 11.3% （7/62） at one week after procedure, and the incidence of restenosis at one year after stenting was 19.4% （ 12/62 ）. ③Diabetes and residual stenosis were an important risk factor for restenosis after stenting（P = 0. 024, OR = 7. 048,95% CI 11. 286 - 38. 617; P = 0. 040, OR = 8. 995, 95% CI1. 110 - 72. 911 ）. ④Whether regularly taking lipid-lowering drugs, there was significant difference in the incidence of MCA restenosis （7.4% 2/27] vs. 36. 4%8/22] ; P = 0.032）. Conclusion TCD can be served as an impor- tant means to objectively assess the hemodynamic changes before and after MCAS stenting and the long-tema clinical observation. Postoperative residual stenosis and diabetes are the risk factors for the occurrence of restenosis. Regularity taking lipid-lowering drugs after procedure may reduce the incidence of MCA restenosis.