64排螺旋CT在颈动脉狭窄中诊断价值

目的:探讨64层螺旋CT在颈动脉狭窄中的影像学表现及诊断价值评价。方法:对我院已确诊存在不同狭窄程度的35例颈动脉狭窄患者进行回顾性分析,研究64层螺旋CT扫描及三维重建资料,并对其进行效果评价。结果:64层螺旋CT对颈动脉狭窄有很高的临床诊断价值。结论:64层螺旋CT血管快捷、方便、检出率高,对颈动脉狭窄的诊断有较高的临床应用价值。     

颈动脉内膜切除术适应证及疗效评价

目的　讨论颈动脉内膜切除术的适应证及效果。方法　对 8例颈动脉狭窄患者进行超声多普勒及DSA检查后施行了颈动脉内膜切除术 ,对术后患者用超声及DSA进行随访观察。结果　 8例手术患者无脑卒中发生 ,并且无手术后再狭窄。结论　颈动脉内膜切除术是治疗颈动脉狭窄的有效方法 ,适用于有症状、狭窄程度 >5 0 %的患者。但因其为预防性手术 ,对无明确颈动脉狭窄患者不宜过于积极行手术治疗。     

中老年人颈动脉狭窄支架置入术并发症的临床观察及防治

目的:总结中老年人颈动脉狭窄支架置入术并发症,提高手术安全性。方法:回顾分析我院2009年1月至2012年3月采用支架置入治疗颈动脉狭窄85例。结果:82例支架植入术获得成功(96.47%),围手术期3例患者死亡(3.52%),2例患者出现急性脑缺血(2.35%),3例患者出现卒中(3.52%),8例患者出现脑血管痉挛(9.41%)。结论:颈动脉支架置入治疗颈动脉狭窄是一种新的治疗方法,手术过程中联合采用多种方法及术后预防性给药可有效减少并发症的发生。     

64排螺旋CT对于颈动脉狭窄患者的诊断价值探讨

目的探讨64排螺旋CT对于颈动脉狭窄的临床诊断价值。方法选取我院在2011年8月---2013年4月间接收的50例疑似颈动脉狭窄患者,将其随机分为两组,各25例,观察组患者采用64排螺旋CT进行诊断,对照组患者采用彩色多普勒超声进行诊断,评估两组患者的诊断效果。结果64排螺旋CT对于颈动脉斑块的检出率明显优于彩色多普勒超声,差异有统计学意义（ P＜0．05）。结论临床应用64排螺旋CT诊断颈动脉狭窄准确率较高,值得推广应用。     

CT或MR造影时虚拟弹力球方法对血管狭窄的可重复性研究

目地本文之目的在于为了开发和评估一种用户友好的工具，以便在CT或MR造影数据集之中．提高血管狭窄测量的效率、精度和可重复性。材料与方法该临床试验得到了制度审查委员会的批准，患者享有知情同意权。动物实验得到了动物保护组织复核委员会的批准．当虚拟弹力球通过一段指定起、止点的血管时，能够记录血管的直径。本研究对其过程进行了模拟测试，并应用微型CT数据集对诱发血管狭窄的小鼠进行了测量，以准确估算血管直径，该研究对16例颈动脉狭窄的患者进行双能CT和MR血管造影，并对比了自动和手动测量技术的可重复性和读取时间。此外，对使用碘与钙造影剂增强双能CT的区别进行了研究，并运用配对资料t检验对小鼠颈动脉直径、自动与手动测量的差别进行了评估，采用Fisherz检验对血管狭窄评分的可重复性进行了评估。结果模拟测量的血管直径平均误差为0．094mm，正常小鼠与颈动脉受伤小鼠的血管直径之间有显著差异（P〈0．01）。对患者数据，自动内部读取的变异性相较手动外部和内部读取显著降低（P〈0．01），同时，时间效率提高（P〈0．01）。结论虚拟弹力球工具适用于CT、双能CT以及MR血管造影，并比手动血管狭窄的测量有着更高的可重复性和效率。     

颈内动脉狭窄的血管内介入治疗

目的:探讨颈动脉(ICA)支架置入术(CAS)对治疗颈动脉狭窄的临床价值。方法:对38例患者颈内动脉狭窄血管内介入治疗的临床应用及操作进行回顾性分析。38例颈内动脉狭窄患者在局麻下行血管内介入支架治疗。结果:所有患者均顺利将支架放置理想位置。其中,7例患者滤网回收后,网内肉眼可见少量大小不等的组织碎片;1例患者在球囊扩张后出现一过性心率减缓;3例患者在回收保护伞时出现血管痉挛,经积极治疗后症状消失或缓解。结论:颈动脉支架置入术是一种创伤小、痛苦小的微创技术,它为颈动脉狭窄的治疗提供了一种新的途径,临床疗效显著。     

血管内支架置入术治疗颈动脉狭窄的护理

颈动脉狭窄是由于颈动脉的粥样硬化斑块导致的颈动脉管腔狭窄的疾病,是脑卒中的重要危险因素,颈动脉狭窄大于70％的患者卒中率可高达13％。近年来,血管内支架置入术（CAS）以其创伤小、痛苦少、易于被患者接受,至今已成为治疗颈动脉狭窄的一种简单、有效的方法[1],笔者所在医院自2009年7月-2010年7月行CAS手术患者12例,     

颈内动脉血管内支架成形术治疗缺血性脑血管病临床分析

目的探讨血管内支架治疗颈动脉狭窄的疗效及安全性。方法2008年7月—2011年7月,对52例颈动脉狭窄患者采用颈动脉血管内支架成形术治疗,所有病例均使用远端保护装置,全身肝素化下置入自膨支架治疗颈动脉分叉部狭窄。结果52例患者共置入54枚支架,手术成功率100％,术后造影显示支架形态良好;术后6个月采用颈动脉彩超复查,未发现病变血管再狭窄。结论颈内动脉支架成形术治疗高危颈动脉硬化狭窄疾病有良好的安全性和确切的疗效。     

颈动脉狭窄成形术中的支架和脑保护装置选择

颈动脉狭窄是缺血性脑卒中的主要发病原因之一，而颈动脉支架及其脑保护装置是经血管内治疗颈动脉狭窄的有益材料。通过了解和熟悉不同类型的支架和脑保护装置的特点、特性、应用方法和并发症预防．有助于提高颈动脉狭窄成形治疗的临床水平。     

颈动脉狭窄的血管内支架治疗及并发症分析

目的 探讨颈动脉粥样硬化性狭窄的血管内自膨胀支架治疗的临床价值及并发症分析.方法 经脑血管造影证实的颈动脉狭窄患者16例,应用远端栓子保护装置,球囊预扩张狭窄部位,释放自膨支架.结果 所有支架释放定位准确,狭窄消除,围手术期出现1例脑出血.临床随访1例再发短暂性脑缺血发作,超声示再狭窄.结论 血管内支架成形术是治疗颈动脉狭窄的可行的方法.     

CDFI与TCD联合评价单侧严重颈动脉狭窄或闭塞对颅内循环的影响

目的联合应用经颅多普勒超声（TCD）和彩色多普勒血流显像（CDFI）评估单侧严重颈内动脉狭窄或闭塞对颅内循环的影响。方法对可疑缺血性脑血管病变患者1126例,其中67例CDFI诊断一侧颈内动脉严重狭窄或闭塞患者,采用TCD技术检测其颅内动脉的流速及Willis环和眼动脉侧支开放情况。结果 CDFI显示狭窄处峰值血流速度及舒张期血流速度明显增快。TCD显示：①病变侧的大脑中动脉流速明显低于健侧;②Willis环代偿组患侧MCA流速明显高于颈内外侧支代偿组;③ACoA与中风的发生负相关。结论 TCD、CDFI的联合应用可以全面观察整个颈动脉系统的血液动力学改变,为下一步的治疗提供可靠的依据。     

颈动脉内膜剥脱术治疗症状性颈内动脉狭窄的疗效分析

目的 探讨颈动脉内膜剥脱术治疗症状性颈内动脉狭窄的效果.方法 回顾性分析2016年1月-2018年12月在朝阳市中心医院神经外科,行颈动脉内膜剥脱术治疗的46例症状性颈内动脉狭窄患者的临床资料,从神经功能、脑血流动力学及围手术期和远期不良事件等方面评价其治疗效果及安全性.结果 与术前相比,术后3个月患者狭窄段血管内径增大、狭窄段收缩期峰值血流速度降低,差异均有统计学意义(P<0.05).患者术后3个月改良Rankin量表评分较术前降低、蒙特利尔认知评估量表评分较术前提高,差异均有统计学意义(P<0.05).围手术期不良事件:术后出现脑过度灌注综合征、颈部切口积脓、心律失常、突发脑干出血死亡各1例.远期不良事件:术后4个月和8个月出现脑梗死各1例;术后5个月出现动脉内夹层1例.结论 颈动脉内膜剥脱术可有效改善症状性颈内动脉狭窄患者的神经功能和脑供血情况,疗效确切,安全性高.     

Risk factors for carotid artery stenosis: an epidemiological study of men aged 69 years

Four hundred and seventy-eight men born in 1914 and residing in the city of Malm?, Sweden, underwent ultrasonic Doppler examination of the carotid arteries in 1982/83. The known risk factors for vascular disease--blood pressure, lipids, glucose, hematocrit, alcohol consumption and Body Mass Index were also measured. A moderate stenosis (diameter reduction 30-59%) of the internal carotid artery was found in 95 men (20%); 15 men (3%) had a greater than or equal to 60% stenosis of the internal carotid artery, while 7 (1.5%) had complete unilateral occlusion. Smoking was found to be significantly related to severe carotid artery disease. There was also a significant correlation between maximum flow velocity in the internal carotid artery and triglycerides. Those quitting smoking before the age of 50 had the same incidence of internal carotid artery disease as non-smokers, while those quitting later in life had a slightly higher incidence than life-long smokers.     

经颅多普勒在颈内动脉颅外段病变侧支循环建立的诊断价值

目的 探究经颅多普勒在颈内动脉颅外段病变侧支循环建立的诊断价值。方法 选取2017年11月—2019年12月于我院进行检查的颈内动脉颅外段病变患者175例,所有患者均行DSA及经颅多普勒超声检查。以DSA检查为诊断颈内动脉颅外段病变“金标准”,分析DSA及经颅超声检查结果,另分析经颅多普勒超声在前交通动脉、后交通动脉、颈内外侧支开放诊断价值及颅外段病变程度及侧支循环情况。结果 DSA共检出前交通动脉开放125例,后交通动脉开放88例,颈内外动脉侧支开放76例;经颅多普勒超声检查共检出前交通动脉开放86例,后交通动脉开放98例,颈内外侧支开放74例。经颅多普勒超声在前交通动脉诊断中灵敏度为64.80%、特异度为90.00%、准确度为72.00%、假阳性率为10.00%、假阴性率为35.20%;后交通动脉诊断中灵敏度为89.77%、特异度为78.16%、准确度为84.00%、假阳性率为21.84%、假阴性率为10.23%;颈内外动脉侧支开放诊断中灵敏度为88.16%、特异度为92.93%、准确度为90.86%、假阳性率为7.07%、假阴性率为11.84%;重度狭窄或闭塞患者有侧支循环开放率高于轻中度狭窄者,而轻中度狭窄者无侧支循环开放率高于重度狭窄或闭塞者,差异有统计学意义(χ2=9.526,P=0.002)。结论 经颅多普勒在颈内动脉颅外段病变侧支循环建立评估中具有较高的临床应用价值,可将其作为疾病诊断的重要方法,值得推广应用。     

Color coded duplex scanning examination of the carotid artery

A recent developed ultrasound technology that combines the B-mode real time imaging, colour flow imaging and pulsed Doppler velocity measurements with spectral analysis was used for bilateral carotid artery examinations of 81 patients with suspicion of carotid stenosis. The results in 9 cases was compared with angiographic findings. This paper describes the basic principles of this method, the fundamental of the estimation of the lumen reduction. Authors present the advantages and limitations of this method and conclude that the colour coded duplex scanning sonography is an accurate noninvasive technique that suitable for detection of the extracranial carotid artery diseases. They emphasize that in all of 5 cases with amaurosis fugax significant homolateral stenosis was found in the communis or internal carotid artery.     

经颅多普勒超声对颈内动脉颅内段狭窄的诊断价值评估

目的评估经颅多普勒超声(TCD)对颈内动脉(ICA)颅内段狭窄的诊断价值。方法对2011~2013年某院神经内科收治的329例首发症状为短暂性脑缺血发作(TIA)或脑卒中且具备脑血管狭窄危险因素的患者,在发病3d内先后行TCD及计算机断层扫描血管造影术(CTA)检查,进行自身对照,比较两种方法之间的差异;以CTA为诊断标准,确定ICA颅内段狭窄的血管条数,然后对CTA证实ICA颅内段狭窄的患者的TCD资料进行回顾分析,分别计算TCD诊断不同程度ICA颅内段狭窄的灵敏度、特异度、阳性预测值、阴性预测值、准确度并分析TCD诊断颅内动脉病变的价值。结果 (1)对颈内动脉颅内段狭窄病例,TCD敏感性是81.3%,特异性是94.3%,阳性预测值是70.9%,阴性预测值96.7%,准确度92.4%。(2)侧支循环开放,重度狭窄患者75.8%存在侧支循环开放,中度及轻度狭窄患者未见侧支循环开放病例。(3)对诊断ICA颅内段狭窄,TCD与CTA相比,差异无统计学意义。结论 TCD对ICA颅内段重度狭窄、闭塞的患者具有较高的诊断价值,可作为筛查颈内动脉颅内段狭窄的首选检查手段,可作为血管内支架置入血管成形术术前筛查及术后复查的手段。     

Comparison of blood flow velocity through the internal carotid artery based on Doppler ultrasound and numerical simulation

Doppler ultrasound is a usual non-invasive method to estimate the stenosis percentage in large arteries such as carotid by measuring maximum velocity of blood flow. Based on clinical investigations, because of vessel wall motions, Doppler positioning and angle correction, some errors can arise in Doppler results which lead to incorrect diagnosis. The aim of this study was to compare the results of Doppler test and the numerical simulation of blood flow in the same case. For this evaluation, two patients including an 87-year-old man and a 72-year-old woman suffering from stenosis in the internal carotid artery were selected. First, clinical information of each patient such as CT-Angio scan images and Doppler ultrasound results on different locations of the stenosed artery were obtained. Then, the geometries were reconstructed and numerical simulations were carried out using ANSYS software. Results showed that the velocity profile of Doppler test and numerical simulation were in good agreement at the regions of pre-and post-stenosis. However, the value of maximum velocity at the stenotic region had significant differences.     

磁共振3D TOF MRA技术在颈动脉血管成像中的应用

目的:通过改变常规3D TOF MRA扫描参数,克服不能进行从主动脉弓到颈内外动脉分叉大范围成像的限制,探讨其在颈动脉血管成像中的应用价值。方法:对108例脑血管病患者进行颈动脉3D TOF MRA检查。主要是去除扫描选项中ZIP2,增加扫描块,满足从主动脉弓至颈内外分叉处的大范围成像。图像经MIP、MPR、VR处理,由两名高年资MR诊断医师分别对双侧颈总、颈内外、椎动脉进行成像质量分析。结果:3D TOF MRA共观察血管864支,其中显示清晰且正常者672支;血管显示不清17支,先天变异17支,管壁不光滑73支,血管狭窄63支,血管闭塞9支,血管未显示5支,受压移位4支,血管膨大4支,即显示不清、变异及病变者共计192支。结合原始图像分析,均能达到诊断要求。结论:3D TOF MRA作为一种无创的、不用对比剂的成像方法,用于颈动脉狭窄的筛选,具有较好的临床应用价值。     

High-flow transcranial bypass for prevention of brain ischemia

In patients in whom the internal carotid artery has to be occluded because of the presence of an intracranial giant aneurysm or an infiltrating skull base tumour and in patients with brain ischaemia, whose internal carotid artery has been occluded spontaneously on the basis of atherosclerosis, a transcranial bypass can be created. Since the beginning of the seventies 'low-flow bypasses' are made in which a branch of the superficial temporal artery is connected with a cortical branch of the middle cerebral artery. Because of the small calibre of the blood vessels involved the desired effect on the brain circulation is limited. Thanks to the nonocclusive Excimer laser-assisted anastomosing technique, developed by Tulleken et al. in the last fifteen years, it is now possible to create a high-flow bypass in a safe way. A donor vessel, e.g. the V. saphena magna, is connected at one end to the external carotid artery and at the other to the intracranial part of the internal carotid artery beyond the pathological lesion. The mean flow through the bypass was 140 ml/min in about 90 patients. For example, in three patients, a woman aged 45 with rightsided progressive ophthalmoplegia due to a giant aneurysm, a woman aged 31 years with an aneurysm in the right middle ear and a man with a chemodectoma at the base of the skull, a transcranial high-flow bypass was created nonocclusively, after which the internal carotid artery was closed without any problems.