颈动脉夹层的超声表现及漏诊分析

目的 探讨颈动脉夹层超声表现，分析超声检查的漏诊原因。方法 回顾性分析经高分辨率MRA/CTA/DSA确诊的28例颈动脉夹层的超声图像，观察颈动脉夹层的声像图特征，分析超声漏诊原因。结果 28例颈动脉夹层中，15例超声诊断明确，13例超声漏诊，诊断符合率53.57%（15/28），漏诊率46.43%（13/28）。15例颈动脉夹层的超声表现为"双腔征"7例，壁内血肿6例，闭塞或重度狭窄提示颈动脉夹层2例；15例中合并血流异常15例，合并频谱异常7例；超声漏诊13例中，6例超声阴性，7例仅提示重度狭窄或闭塞及频谱异常。结论 颈动脉夹层超声表现以"双腔征"和壁内血肿较常见。年轻且无动脉粥样硬化者，若出现颈动脉重度狭窄或闭塞以及血流动力学异常时，需高度警惕颈动脉夹层。     

超声、磁共振联合评价急性脑梗死颈动脉狭窄病变

目的 评价彩色多普勒超声、磁共振血流成像(MRA)对急性脑梗死颅外段颈动脉狭窄诊断的价值.方法 对32例临床怀疑颈动脉狭窄的急性脑梗死患者行彩色多普勒超声、磁共振血流成像(MRA)及数字减影血管造影(DSA)检查,以NASCET法计算狭窄率.结果 以DSA诊断为金标准,32例128条颅外段颈动脉狭窄超声诊断的敏感性88.33%,特异性94.59%,准确性89.84%,Kappa=0.65;MRA诊断的敏感性62.96%,特异性100%,准确性84.38%,Kappa=0.59;超声联合MRA诊断的敏感性为90.74%,特异性94.59%,准确性92.97%,Kappa=0.84.结论 超声诊断颈动脉颅外段狭窄的敏感性、准确性均高于MRA,适用于人群初选检查.超声联合MRA诊断颅外段颈动脉狭窄与DSA一致性较好,但不能完全取代DSA.     

颈部动脉夹层的超声影像特征分析

目的总结颈部动脉夹层的超声影像特征,以期提高超声对其的诊断准确率。方法选取18例经DSA、CTA或MRI证实的颈动脉夹层患者,回顾性分析其超声影像资料,总结其超声影像特征。结果 18例颈部动脉夹层患者共21根血管,超声准确诊断13例共15根血管,准确率71%。13例患者15根血管超声表现为"双腔征"(真腔和假腔),血管腔内见膜带状回声;3例患者4根血管超声表现为锥形不规则狭窄,疑为动脉夹层;2例患者2根血管超声表现为动脉管腔远端充满低回声,未见血流充盈,诊断为闭塞。结论颈部动脉夹层的超声特征具有一定特异性,超声可作为其首选检查方法。     

微血流成像技术在椎动脉夹层诊断中的应用价值

目的 探讨微血流成像技术(SMI)对椎动脉夹层(VAD)的诊断效果。方法 回顾性分析20例VAD患者的临床资料,患者均接受常规超声检查、彩色多普勒超声(CDFI)、SMI检查和数字血管减影造影术(DSA)或者磁共振血管成像(MRA)或者计算机断层血管造影(CTA),对比常规超声、SMI、MRA/CTA/DSA的影像表现。结果 与健侧相比,患侧的真腔管径更小,原始管径更大,收缩期峰值流速(PSV)、阻力指数(RI)及舒张期流速(EDV)值更高(P<0.05)。常规超声对VAD的检出率为50.00%(V1段3例,V2段7例,V3段5例),SMI对VAD的检出率为90.00%(V1段6例,V2段12例,V3段13例)。SMI对VAD的检出率显著高于常规超声(P<0.05),SMI与CTA/MRA/DSA对VAD的检出率接近(P>0.05)。常规超声与MRA/CTA/DSA检出VAD的一致程度不够理想(Kappa=0.368);SMI与MRA/CTA/DSA检出VAD具有较强的一致性(Kappa=0.782)。常规超声与MRA/CTA/DSA检出壁内血肿型VAD的一致程度不够...     

短暂性脑缺血发作的颈动脉超声和影像学表现及评价

目的评价颈动脉超声、磁共振（MRI）、磁共振血管造影（MRA）及数字减影血管造影（DSA）对短暂性脑缺血发作（TIA）的诊断价值。方法90例颈动脉及椎基底动脉TIA患者分别进行CT、MRI、MRA、颈动脉超声及DSA检查。结果15例（16.7％）TIA患者CT、MRI显示有小血管腔隙性梗死,20例（22.2％）CT正常,MRI的他加权像显示有小的梗死灶,60例患者行颈动脉超声检查,40例（66.7％）显示有动脉硬化及管腔狭窄。有30例行MRA及DSA检查,14例（46.7％）MRA有异常,22例（73.3％）DSA显示颈动脉和相应动脉的狭窄或闭塞。结论CT及MRI是诊断TLA的筛选手段,颈动脉超声、MRA及DSA对TIA的诊断及预后的估计具有重要意义。     

三维超声造影评价肝动脉解剖分型的价值

目的探讨三维超声造影评价肝动脉解剖分型的应用价值。方法对10例上腹部肿瘤患者和20例拟捐献供肝的活体肝移植供体的肝脏行二维超声造影和三维超声造影检查。肝动脉解剖分型参照Michels分型标准,以CTA/MRA/DSA/手术为对照,比较二维超声造影与三维超声造影判断肝动脉解剖分型的符合率。结果二维超声造影与三维超声造影判断肝动脉解剖分型的总符合率分别为40.0%(12/30)和83.3%(25/30),两者之间的差异有统计学意义(P=0.000)。其中对于正常解剖类型,二维超声造影与三维超声造影判断符合率分别为40.9%(9/22)和90.9%(20/22),两者之间的差异有统计学意义(P=0.000);对具有解剖变异类型病例,二维超声造影与三维超声造影判断符合率分别为37.5%(3/8)和62.5%(5/8),两者之间的差异无统计学意义(P=0.196)。结论三维超声造影是评价肝动脉解剖结构及变异的新方法,可能成为CTA、MRA、DSA等的重要补充。     

MRA联合TCD对烟雾病成年患者血管狭窄程度诊断符合率的影响

目的:探讨核磁共振(MRA)联合经颅多普勒超声(TCD)对烟雾病成年患者血管狭窄程度诊断符合率的影响。方法:选取2015年9月~2017年9月我院28例烟雾病成年患者(56侧血管),均行MRA、TCD及数字减影血管造影(DSA)检查,以DSA检查结果为金标准,统计对比MRA与TCD联合及单一诊断其血管狭窄程度的符合率。结果:DSA检查结果显示,28例患者的56侧血管中正常9侧、狭窄20侧、闭塞27侧;应用MRA检出正常6侧,狭窄10侧,闭塞27侧,TCD检出正常5侧,狭窄11侧,闭塞24侧,两者联合检出正常8侧,狭窄18侧,闭塞27侧;以DSA检查结果作为金标准,MRA与TCD联合诊断烟雾病成年患者血管狭窄程度的符合率94. 64%(53/56)均高于MRA、TCD单一方法诊断的76. 79%(43/56)、71. 43%(40/56),差异有统计学意义(P 0. 05)。结论:采用MRA与TCD联合诊断可明显提高烟雾病成年患者血管狭窄程度的诊断符合率,为临床诊治提供可靠依据。     

超声造影在检测肝移植术后肝动脉并发症中的应用

目的评价超声造影在检测肝移植术后肝动脉并发症中的应用价值。方法选择肝移植术后患者经彩色多普勒超声检查疑肝动脉血流异常者53例,用SonoVue及实时超声造影匹配成像技术行超声造影检查,观察肝动脉及肝实质的血流灌注。结果25例经DSA或CT血管造影（CTA）/MR血管造影（MRA）证实,其中肝动脉狭窄22例,血栓闭塞3例。与DSA或CTA/MRA比较,超声造影诊断血栓闭塞符合率为100%（3/3）,判断肝动脉狭窄部位诊断符合率为90.9%（20/22）,显示血管狭窄程度的符合率为86.4%（19/22）。结论超声造影可明确诊断血栓闭塞,可较准确地判断肝动脉狭窄部位及程度,有利于提高肝移植术后肝动脉并发症的诊断准确性。     

三种影像学检查对颈动脉狭窄的诊断价值

目的 探讨无创性影像检查对颈动脉狭窄的诊断价值.方法 对42例临床疑为颈动脉狭窄的患者行彩色多普勒超声(CDFI)、磁共振血管成像(MRA)及数字减影血管造影(DSA)检查,以颈总动脉法(CC法)计算狭窄率.结果 CDFI对颈动脉斑块的检出率明显优于MRA、DSA.以DSA检查结果为金标准,CDFI和MRA诊断颈动脉狭窄及闭塞的敏感性、特异性及准确性分别为 90.9% vs 94.5%、65.5% vs 86.2%和82.1% vs 91.7%.结论 无创性影像检查(CDFI、MRA)在诊断颈动脉狭窄及闭塞方面具有互补作用,应该配合应用,可作为普查和筛选的手段.     

颅外段椎动脉夹层的超声诊断价值

目的探讨颅外段椎动脉夹层超声诊断价值。方法连续性收集本院神经内科住院且颈部动脉超声检查诊断为颅外段椎动脉夹层的34例患者,对比分析各种影像学资料,评价超声的诊断价值。结果 34例椎动脉夹层中,壁内血肿型夹层27例(79.4%)、双腔型夹层1例(2.9%)、闭塞型夹层6例(17.7%)。19例患者进行DSA、MRA或CTA检查,以任意两种及以上影像学检查综合诊断为金标准,超声诊断颅外段椎动脉夹层的ROC曲线下面积为0.952。结论颅外段椎动脉夹层以壁内血肿型最多见,典型的双腔型夹层少见。超声诊断各型颅外段椎动脉夹层均为直接征象、可靠性强、诊断价值高。     

Management of patients with concomitant coronary and carotid artery disease

Introduction: Ideal management of concomitant carotid and coronary artery occlusive disease remains under investigation. Although researchers have advocated the potential benefits of varying treatment strategies based on either concomitant or staged surgical treatment, there is no consensus in treatment guidelines. With emerging data suggesting favorable outcome of carotid artery stenting (CAS) compared to carotid endarterectomy (CEA) in patients with critical coronary artery disease, physicians must consider these diverging therapeutic options.

Areas covered: This review presents current evidence regarding the prevalence of carotid stenosis in patients with coronary artery disease, the common pathophysiologic links with an emphasis on the diverse mechanisms of stroke in the coronary artery bypass grafting (CABG) setting and discusses the contemporary registries and observational studies comparing outcomes of various revascularization strategies in high-risk patients. Authors conducted a literature search in two bibliographic databases including papers published from 1983 until 2018 (PubMed, Scopus).

Expert opinion: Symptoms should drive the need to intervene on carotid stenosis in patients undergoing coronary revascularization. Carotid artery stenting has gained significant ground, especially among those individuals considered of high surgical risk. PCI may be considered as an alternative option for the management of severe concurrent coronary disease.     

颈动脉重建术治疗颈动脉瘤的护理配合

[目的]探讨颈动脉重建技术在颈动脉瘤手术治疗中的护理配合.[方法]对19例因颈动脉瘤行颈动脉重建术病人做好充分术前准备,术中配合默契、熟练,密切关注手术进程.[结果]手术过程顺利,病人术后安返病房,无严重并发症发生,达到满意的手术及护理效果.[结论]术前充分有效的准备,术中准确、科学的护理配合可使手术顺利进行,也是手术成功的重要保证.     

Bilateral carotid artery dissection after dental work

Carotid artery dissection has been reported to occur spontaneously and after many types of neck trauma. A case patient is presented who developed a right-sided oculosympathetic palsy and was found to have bilateral carotid artery dissection after she visited her dentist. To the best of our knowledge, this case represents the first report of bilateral carotid dissection following dental work.     

缺血性脑血管病患者的颈动脉粥样硬化临床研究

目的分析国人颈动脉粥样硬化（CAS）斑块发病特征及与缺血性脑血管病的相关性。方法以2006年6月至2009年6月在安徽铜陵有色职工总医院神经内科住院的164例急性缺血性脑血管病患者为研究对象,应用超声诊断仪检测双侧颈动脉,评价粥样硬化斑块的发病部位、形态、大小与数目,采用非条件多元逻辑回归分析颈动脉粥样硬化的危险因素及与缺血性脑血管病的关系。结果85.9%（141/164）患者存在不同程度颈动脉粥样硬化。颈动脉粥样硬化病变特点以斑块多见（134/164,81.7%）,中重度狭窄发生率较低（26/164,15.8%）;颈动脉斑块以颈总动脉分叉处最多见（69/134,51.4%）。斑块发生率及颅外段颈动脉狭窄程度与脑血管病危险因素有明显相关性。结论缺血性脑血管疾病患者颈动脉粥样硬化病变可能以斑块居多,颈动脉粥样硬化与缺血性脑血管病有关。     

颈动脉重建术治疗颈动脉瘤的护理配合

[目的]探讨颈动脉重建技术在颈动脉瘤手术治疗中的护理配合.[方法]对19例因颈动脉瘤行颈动脉重建术病人做好充分术前准备,术中配合默契、熟练,密切关注手术进程.[结果]手术过程顺利,病人术后安返病房,无严重并发症发生,达到满意的手术及护理效果.[结论]术前充分有效的准备,术中准确、科学的护理配合可使手术顺利进行,也是手术成功的重要保证.     

高频超声检测颈动脉早期诊断颅内颈内动脉系统远端阻塞性病变

目的：利用高频超声检测颈动脉早期诊断颅内颈内动脉系统远端阻塞性病变。方法：对三组（正常组、无脑梗死颈动脉粥样硬化组、脑梗死颈动脉粥样硬化组）共120例患者行超声检查颈动脉，观察动脉硬化情况，记录血流值。对三组同侧颈内动脉与颈总动脉血流收缩期血流速度比值（ICA／CCA）进行统计学F检验。结果：正常组、无脑梗死颈动脉粥样硬化组与脑梗死颈动脉粥样硬化组的IcA／CCA比值有统计学显著差异（P〈0．05），正常组与无脑梗死颈动脉粥样硬化组的ICA／CCA比值无统计学显著差异（P〉0．05）。结论：同侧颈内动脉与颈总动脉血流收缩期血流速度比值（ICA／CCA）有助于早期诊断颅内颈内动脉系统远端阻塞性病变。     

颈动脉狭窄围手术期的护理体会

【】目的：探讨及对比颈内动脉内膜剥脱(CEA)和颈内动脉支架成型(CAS)两种手术方式围手术期护理措施。方法：回顾总结分析53例颈内动脉狭窄手术患者的临床资料及护理经验。结果: 53例患者均康复出院。结论：护理指导贯穿患者围手术期治疗的始终,有效改善颈动脉狭窄患者术后的生命质量。     

颈内动脉严重狭窄或闭塞后颈总动脉与颈内动脉虹吸段血流频谱的改变

目的：分析颈内动脉严重狭窄或闭塞（ＩＣＡＳＯ）后颈总动脉（ＣＣＡ）和颈内动脉虹吸段（ＳＩＰＨＡ）血流频谱的改变,提高经颅多普勒超声（ＴＣＤ）对ＩＣＡＳＯ的检出率和准确性。方法：ＩＣＡＳＯ患者１２０例,全部经颈部血管彩超检查证实,其中６２例经脑血管造影（ＤＳＡ）进一步确诊双侧病变３３例,单侧病变８７例,共有病变血管１５３条（狭窄９４条,闭塞５９条）。全部行ＴＣＤ检查。结果：（１）狭窄或闭塞侧颈总动脉     

Optimal management of patients with symptomatic and asymptomatic carotid artery stenosis: work in progress

The optimal management of patients with symptomatic and asymptomatic carotid artery stenosis remains a subject of extensive debate. Several international societies and associations have published guidelines for the management of carotid patients. Although these recommendations are based on the same randomized trials, differences in interpretation of available knowledge have often led to different (or even conflicting) recommendations. This special report summarizes the current evidence-based optimal management of patients with symptomatic and asymptomatic carotid stenosis and compares key international guidelines. Finally, issues requiring further research are identified and discussed.     

Review article: Non-penetrating neck artery dissection in young adults: Not to be missed!

Young adults who present to the ED with neck pain following non-penetrating, seemingly trivial trauma to the neck, are at risk of neck artery dissection and subsequent stroke. Sport-related neck injury is the chief cause. Physical examination may often be unremarkable, and although there may be reluctance to expose young patients to radiation, radiological imaging is central to making a diagnosis of arterial wall disruption. A comprehensive literature search was performed in relation to neck artery dissection, and the evidence was scrutinised. We discuss the typical mechanism of injury, symptoms, anatomical considerations and clinical aids in diagnosis of neck artery dissection. Although the incidence is low, neck artery dissection has a mortality of 7%. As such, it is important for front-line physicians to have a high suspicion of the diagnosis and a low threshold to organise radiological examinations, specifically computerised tomography. Early detection of neck artery dissection will trigger clinical protocols that call for multi-disciplinary team management of this condition. In general, guideline-based recommendation for the management of neck artery dissection involving an intimal flap is by anti-platelet therapy while treatment of neck artery dissection that results in a pseudo-aneurysm or thrombosis is managed by surgical intervention or endovascular techniques. Close follow up combined with antithrombotic treatment is recommended in these individuals, the goal being prevention of stroke.