大脑中动脉重度狭窄"亚满意"支架成形术前后的血流动力学参数分析

目的探讨大脑中动脉(MCA)M1段重度狭窄"亚满意"成形术前、后血流动力学参数的变化。方法回顾性分析2016年1月至2020年5月郑州大学人民医院脑血管介入治疗中心采用Enterprise支架治疗的20例MCA M1段重度狭窄患者的临床资料。对所有患者手术前、后均行头颅数字减影血管造影(DSA)检查,根据脑血管旋转造影数据建立数值模型,应用血流动力学系列软件计算手术前、后及计算机模拟狭窄部位完全修复后狭窄局部、狭窄近端、远端正常血管及穿支根部的壁剪切力和管腔内总压力。术后复查DSA判断血管狭窄程度,以残余狭窄率<30%(定义为"亚满意")为手术成功。结果20例患者的手术均成功。术后即刻造影显示MCA狭窄率较术前明显降低分别为(29.9±13.2)%、(86.6±10.0)%,t=15.31,P<0.05]。20例患者术后MCA狭窄部位和穿支根部的壁剪切力均较术前降低狭窄部:(25.1±4.6)Pa、(49.0±13.2)Pa,穿支根部:(1.1±0.2)Pa、(3.5±0.4)Pa,均P<0.05],而狭窄近端和远端正常血管的壁剪切力均较术前增高近端:(7.2±3.8)Pa、(3.6±2.6)Pa,远端:(12.6±5.8)Pa、(4.9±2.6)Pa,均P<0.05]。术后狭窄部位和近端正常血管壁面的总压力均较术前降低狭窄部位:(276.5±86.3)Pa、(992.6±15.7)Pa,狭窄近端:(605.4±27.8)Pa、(992.6±15.7)Pa,均P<0.05],而穿支根部和狭窄远端正常血管的总压力均较术前增高穿支根部:(58.2±5.6)Pa、(2.7±0.3)Pa,狭窄远端:(101.0±43.4)Pa、(10.3±4.3)Pa,均P<0.05]。通过计算机技术将狭窄部位管腔恢复至同两端血管完全一致时,狭窄部位、狭窄近端、远端正常血管及穿支根部的壁剪切力、总压力与术后的差异均无统计学意义(均P>0.05)。结论MCA M1段重度狭窄"亚满意"成形术后狭窄局部、近端、远端正常血管及穿支根部的血流动力学参数均较术前发生明显改变,且达到较理想的血流动力学状态。

Analysis of hemodynamic parameters before and after submaximal angioplasty for symptomatic severe stenosis of M1 segment in middle cerebral artery

Objective To investigate the hemodynamic changes after the submaximal angioplasty in severe stenosis of M1 segment of MCA(middle cerebral artery).Methods Data from 20 patients with severe stenosis of the M1 segment of MCA who underwent the treatment with Enterprise stent at Cerebrovascular Division of Interventional Therapy Center,Zhengzhou University People′s Hospital from January 2016 to May 2020 were prospectively enrolled into this study.The DSA examination of the skull was performed before and after surgery on all patients.A digital model was established of cerebrovascular rotational DSA data,and a hemodynamic software was used to analyze the wall shear stress(WSS)and total pressure(TP)at the stenosis site,proximal normal segment of artery,distal normal segment of artery and root of the lenticulostriate artery before surgery,after surgery,and after digital stenosis repairing with computer technology.The extent of stenosis was assessed post operation,and the residual stenosis rate<30%was used as standard for successful operation.Results The operations were all successful in 20 patients.Immediate postoperative radiography showed that the rate of stenosis decreased significantly(29.9±13.2%vs.86.6±10.0%,t=15.31,P<0.05).The values of WSS at the stenosis and root of the lenticulostriate artery decreased significantly(stenosis:25.1±4.6 Pa vs.49.0±13.2 Pa,root of the lenticulostriate artery:1.1±0.2 Pa vs.3.5±0.4 Pa,P<0.05).However,the values of WSS in proximal and distal normal segments of artery were higher than those before operation(proximal normal segment:7.2±3.8 Pa vs.3.6±2.6 Pa,distal normal segment:12.6±5.8 Pa vs.4.9±2.6 Pa,both P<0.05).The TPs at the stenosis and proximal normal segment of vessel were lower than those before operation(stenosis site:276.5±86.3 Pa vs.992.6±15.7 Pa,proximal normal segment:605.4±27.8 Pa vs.992.6±15.7 Pa,both P<0.05).The TP values at root of the lenticulostriate artery and distal normal segment of artery were higher than those before operation(root of the lenticulostriate artery:58.2±5.6 Pa vs.2.7±0.3 Pa,distal normal segment:101.0±43.35 Pa vs.10.3±4.3 Pa,both P<0.05).However,there was no significant difference between TP and WSS values at the stenosis,proximal and distal segments of artery as well as root of the lenticulostriate artery after submaximal angioplasty and those after stenosis repairing with computer technology(all P>0.05).Conclusion In patients with severe stenosis of M1 segment of MCA after the submaximal angioplasty,the hemodynamics parameters at stenosis site,proximal normal segment,distal normal segment and root of the lenticulostriate artery have significant changes compared those before operation and reach an ideal hemodynamic state.