颈动脉内膜切除术治疗颅外颈内动脉重度狭窄近、远期疗效

目的　评价颈动脉内膜切除术治疗颅外颈内动脉重度狭窄近、远期疗效。方法　 1993年 5月至 2 0 0 0年 6月 ,共 2 0例患者在中山医院接受 2 1次颈动脉内膜切除术。男性 19例 ,女性 1例 ,年龄 4 7- 76岁 ,平均 6 4± 9岁。其中缺血性中风患者 7例 ,一过性脑缺血者 11例 ,无神经症状者 2例。所有患者均行术前颈动脉Duplex超声检查 ,19例同时行DSA检查 ,18例行MRA检查。狭窄度测定方法同NASCET。 2 1侧手术的颈内动脉中 ,19侧狭窄≥ 70 % ,2侧狭窄 6 0 % - 6 9%伴斑块溃疡。手术均采取颈丛麻醉 ,术中选择性地应用转流管和补片缝合。术后定期行超声检查和随访。结果　术后 30天内无死亡和中风。围手术期有 1例TIA和 2例术后颅神经损伤。 2 0例患者随访 1- 6 3月 ,平均31± 2 0月。术后 2年生存率和中风发生率为 92 3%和 0 % ,5年生存率和中风发生率为 79 1%和 12 5 %。 2例随访中超声检查发现手术侧颈内动脉 5 0 % - 6 0 %的再狭窄。结论　本组病例中 ,颈动脉内膜切除术治疗颅外颈内动脉重度狭窄取得了满意的围手术期结果和预防中风的远期疗效。     

颈动脉内膜切除术治疗颅外颈内动脉重度狭窄近、远期疗效

目的　评价颈动脉内膜切除术治疗颅外颈内动脉重度狭窄近、远期疗效.方法　1993年5月至2000年6月,共20例患者在中山医院接受21次颈动脉内膜切除术.男性19例,女性1例,年龄47-76岁,平均64±9岁.其中缺血性中风患者7例,一过性脑缺血者11例,无神经症状者2例.所有患者均行术前颈动脉Duplex超声检查,19例同时行DSA检查,18例行MRA检查.狭窄度测定方法同NASCET.21侧手术的颈内动脉中,19侧狭窄≥70%,2侧狭窄60%-69%伴斑块溃疡.手术均采取颈丛麻醉,术中选择性地应用转流管和补片缝合.术后定期行超声检查和随访.结果　术后30天内无死亡和中风.围手术期有1例TIA和2例术后颅神经损伤.20例患者随访1-63月,平均31±20月.术后2年生存率和中风发生率为92.3%和0%,5年生存率和中风发生率为79.1%和12.5%.2例随访中超声检查发现手术侧颈内动脉50%-60%的再狭窄.结论　本组病例中,颈动脉内膜切除术治疗颅外颈内动脉重度狭窄取得了满意的围手术期结果和预防中风的远期疗效.     

Early and late outcomes in Hong Kong Chinese patients undergoing carotid endar terectomy

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颈内动脉狭窄的手术治疗

目的总结颈内动脉内膜切除术(CEA)治疗颈内动脉重度狭窄的临床经验。方法回顾性分析1998年10月~2006年10月在我科行CEA的95例患者(97次)的临床资料,97次均为初次手术,无二次手术;65例术前有短暂性脑缺血发作(TIA),21例术前曾患脑梗死。所有患者术前经选择性颈动脉造影证实狭窄程度均大于70%,其中50例狭窄程度大于95%,35例对侧伴有颈动脉狭窄或闭塞。颈动脉分叉位置平第2颈椎水平5例,第2颈椎水平以上1例。43例患者术前行冠状动脉造影证实合并冠心病,其中18例同期行冠状动脉搭桥术。结果所有术前有临床症状的患者术后有较明显改善,表现为TIA消失、记忆力明显好转和语言障碍恢复等;1例患者术后出现舌下神经损伤,该患者颈动脉分叉位于第2颈椎水平以上。术后随访6~60个月,1例在随访期间因心脏病死亡,其余患者病情稳定。结论CEA是治疗颈内动脉重度狭窄的安全有效的方法。     

颈动脉支架的安全性和有效性

目的评价颈动脉支架植入安全性和有效性。方法前瞻性观察70位中国人所接受的76次颈动脉内膜旋切术 (CEA),对CAS的安全性及有效性做初步探讨。人选者均属高危患者,包括不稳定型心绞痛、同侧CEA史、对侧颈动脉狭窄、颈动脉放疗后狭窄及其他严重的合并症。患者于术前、术后及半年后随访时均接受独立的神经专科检查;于远期随访时复查脑血管造影。结果手术成功率为100％;术前平均狭窄程度达(82±18)％,术后狭窄程度下降至(5±10)％。所有患者共发生3次小卒中(5．7％),均无大卒中事件;住院期间及术后30 d内均无心肌梗死及死亡事件。平均随访期达 (20±12)月;2例患者发生无症状颈动脉再狭窄;2例患者发生非Q波型心肌梗死;两例患者因非神经源性因素死亡;3 例患者发生小卒中;远期随访未发现大卒中。结论在中国人群中,经皮颈动脉支架植入术是安全可行的,它的远期再狭窄率亦低。     

A study of 510 carotid endarterectomies and a review of the recent carotid endarterectomy trials

The release of several randomized trials comparing carotid endarterectomy (CEA) to other methods of stroke prevention in the early 1990s established CEA as the "gold standard" in the prevention of stroke from carotid occlusive disease. This study examines 510 of the CEAs performed by the first author at Charleston Area Medical Center in Charleston, W. Va., from 1991-99, which were part of three prospective randomized CEA trials at CAMC. All patients were observed clinically and underwent postoperative color duplex ultrasound scans at 30 days, six months, 12 months, and every year thereafter to assess the presence of recurrent stenoses. The overall perioperative stroke rate in the whole series was 2.7% (14/510). The incidence of perioperative ipsilateral stroke was 4.6% for CEA with primary closure vs. 1.9% for CEA with patching (p < 0.05). Patching using PTFE or vein patch closure had the lowest incidence of perioperative stroke rate (0.7%). Primary closure had a statistically significant higher incidence of recurrent stenoses than PTFE or vein patch closure (28% vs. 2.9%, p < 0.0001). The incidence of ipsilateral stroke and recurrent stenosis using the Hemashield patch was higher than either PTFE or vein patch closure. As the indications for CEA expand, the safety, utility, and cost-effectiveness of the procedure must be closely monitored at each institution. However, as shown in this study, CEA (using PTFE or vein patch closure) is a safe, effective, and well-established tool in the treatment of stroke in the 21st century.     

Guidelines for the use of carotid endarterectomy: current recommendations from the Canadian Neurosurgical Society

OBJECTIVE: To develop guidelines on the suitability of patients for carotid endarterectomy (CEA). OPTIONS: For atherosclerotic carotid stenosis that has resulted in retinal or cerebral ischemia: antiplatelet drugs or CEA. For asymptomatic carotid stenosis: CEA or no surgery. OUTCOMES: Risk of stroke and death. EVIDENCE: Trials comparing CEA with nonsurgical management of carotid stenosis. VALUES: Greatest weight was given to findings that were highly significant both statistically and clinically. BENEFITS, HARMS AND COSTS: Benefit: reduction in the risk of stroke. Major harms: iatrogenic stroke, cardiac complications and death secondary to surgical manipulations of the artery or the systemic stress of surgery. Costs were not considered. RECOMMENDATIONS: CEA is clearly recommended for patients with surgically accessible internal carotid artery (ICA) stenoses equal to or greater than 70% of the more distal, normal ICA lumen diameter, providing: (1) the stenosis is symptomatic, causing transient ischemic attacks or nondisabling stroke (including retinal infarction); (2) there is no worse distal, ipsilateral, carotid distribution arterial disease; (3) the patient is in stable medical condition; and (4) the rates of major surgical complications (stroke and death) among patients of the treating surgeon are less than 6%. Surgery is not recommended for asymptomatic stenoses of less than 60%. Symptomatic stenoses of less than 70% and asymptomatic stenoses of greater than 60% are uncertain indications. For these indications, consideration should be given to (1) patient presentation, age and medical condition; (2) plaque characteristics such as degree of narrowing, the presence of ulceration and any documented worsening of the plaque over time; (3) other cerebral arterial stenoses or occlusions, or cerebral infarcts identified through neuroimaging; and (4) surgical complication rates at the institution. CEA should not be considered for asymptomatic stenoses unless the combined stroke and death rate among patients of the surgeon is less than 3%. VALIDATION: These guidelines generally agree with position statements prepared by other organizations in recent years, and with a January 1995 consensus statement by a group of experts assembled by the American Heart Association.     

Preliminary results of combined carotid endarterectomy and off-pump coronary artery bypass grafting in patients with coexistent carotid and coronary artery diseases

Background Coexistent carotid and coronary artery diseases are common and patients with them remain at a high risk for perioperative stroke or myocardial infarction after coronary bypass surgery. The aim of this study was to investigate the effect of combined carotid endarterectomy （CEA） and off-pump coronary artery bypass grafting （CABG） in patients with coexistent carotid and coronary artery diseases. Methods Between January 2002 and December 2007, consecutive patients with coexistent carotid and coronary artery diseases underwent one-stage unilateral CEA and off-pump CABG in Heart Institute of Nanjing First Hospital Affiliated to Nanjing Medical University. Perioperative complications were assessed and follow-up was carried out. Results A total of 51 cases of isolated off-pump CABG and unilateral CEA, including 34 right and 17 left, were performed. The mean blocked time of carotid artery in CEA was （25.5_±7.0） minutes. The mean number of distal grafts per patient was 3.30±0.45. The mean ventilation time, intensive care unit stay, and postoperative hospital stay was （11.3±5.4） hours, （2.1±0.9） days, and （12.5±6.1） days respectively. None of the patients had stroke or myocardial infarct. There was one perioperative death due to acute cardiac failure, resulting in an operative mortality of 1.96%. Follow-up was completed for 47 patients （92.16%） with a mean follow-up of （39.5±12.5） months. None of the patients manifested stroke, new angina or newly developed cardiac infarct. No late death occurred. Conclusion Combined CEA and off-pump CABG is a safe and effective procedure in selected patients with coexistent carotid and coronary artery diseases.     

A meta-analysis of carotid endarterectomy versus stenting in the treatment of symptomatic carotid stenosis

Background  Carotid stenosis is one of the common reasons for patients with ischemic stroke, and the two invasive options carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the most popular treatments. But the relative efficacy and safety of the methods are not clear.

Methods  About 521 articles related to CAS and CEA for carotid stenosis published in 1995–2011 were retrieved from MEDLINE, Cochrane Library (CL), and China National Knowledge Infrastructure (CNKI) China Journal Full-Test database. Of them, eight articles were chosen. Meta-analysis was used to assess the relative risks.

Results  The eight studies included 3873 patients with symptomatic carotid artery stenosis, including 1941 cases in the carotid stent angioplasty group, and 1932 cases in the carotid endarterectomy group. Fixed effect model analysis showed that within 30 days of incidence of all types of strokes, surgery was significantly highly preferred in CAS patients (CAS group) than the CEA patients (CEA group), and the difference was statistically significant (relative ratio (RR)=1.80, 95% confidence interval (CI): 1.380–2.401, P <0.0001). But the incidence of death in the two groups is not showed and is not statistically significant after 30 days (RR=1.52, 95% CI: 0.82–2.82, P=0.18). The rate of cranial nerve injury in the CAS group is lower than the CEA group (RR=0.14, 95% CI: 0.05–0.43, P=0.0005). The incidence of CAS patients with myocardial infarction is lower than the CEA group after 30 days, but statistically meaningless (RR=0.22, 95% CI: 0.05–1.02, P=0.05). The stroke or death in CAS patients were higher than the CEA group after 1 year of treatment (RR=2.58, 95% CI: 1.03–6.48, P=0.04).

Conclusions  Compared to CAS, carotid endarterectomy is still the preferred treatment methodology of symptomatic carotid artery stenosis. Future meta-analyses should then be performed in long-term follow-up to support this treatment recommendation.

     

支架置入术与内膜切除术治疗颈动脉狭窄的系统评价

目的:评价颈动脉血管成形术和颈动脉内膜切除术治疗颈动脉狭窄的近期临床疗效和安全性。方法:电子检索中国学术期刊网全文数据库(1996～2006年)、Medline(1996～2006年)和Cochrane图书馆(2006年12月前已发表的文献和已注册但未发表的临床试验),并与研究者取得联系获得更多的相关研究资料。纳入比较颈动脉血管成形术和内膜切除术治疗颈动脉狭窄的随机对照试验,比较两种治疗方法术后30d内卒中发生率和卒中与死亡的联合发生率。以卒中发生率作为疗效评价指标,以卒中和死亡的联合发生率作为安全性评价指标。2名评价员独立检索和提取资料,对纳入试验的方法学质量进行评价。结果:在术后30d内的卒中发生率方面,共纳入4项临床试验的2541例患者,其中颈动脉血管成形术组1278例,颈动脉内膜切除术组1263例,在术后30d的卒中和死亡的联合发生率方面,纳入5项临床试验,共2760例患者,其中颈动脉血管成形术组1385例,颈动脉内膜切除术组1375例。分析结果显示,在术后30d内的卒中发生率方面,颈动脉血管成形术与颈动脉内膜切除间差异无统计学意义(OR:1144;95%CI:1105～1197,Z=2128,P=0...     

影响颈动脉支架置入术安全性的因素分析

目的探讨颈动脉支架置入术后并发症发生的机制及防治效果,以提高手术的安全性。方法2003年4月至2004年9月间,72例颈动脉狭窄患者进行了经皮腔内血管成形和支架植入术治疗。结果72例患者中有2例出现可逆性小卒中,3例出现术中球囊扩张时对侧肢体局灶性癫痫发作;3例血管痉挛;25例出现低血压、心动过缓;1例出现术后高灌注综合征;5例其他部位的出血。经积极处理后,均未留下严重后果。结论血管内支架成形术治疗是一种治疗颈动脉狭窄安全有效的方法,提高术者操作技巧及围手术期监护可以降低手术并发症和死亡率,提高安全性。     

脑保护装置下支架置入术治疗颈动脉狭窄的临床研究

目的:观察在脑保护装置下颈动脉狭窄支架置入术的应用效果。方法:对30例颈动脉狭窄患者在脑保护装置下使用自膨胀支架行颈动脉支架成形术,共放置支架34枚。结果:支架释放成功率96.7%,手术中无严重并发症发生,手术后未发生小卒中。24例患者手术后3个月颈动脉彩超复查均未见明显再狭窄。结论:颈动脉支架置入术是治疗颈动脉狭窄相对安全有效的方法,这一结果有待长期随访证实,其操作技术及所用材料需进一步探讨。     

斜矢状位黑血MRI增强扫描对颈动脉内膜剥脱手术的术前评估

目的探讨斜矢状位黑血MRI增强扫描对于颈动脉粥样硬化斑块内膜剥脱手术(CEA)的术前评估价值。方法 25例症状性颈动脉粥样硬化患者(26个粥样硬化颈动脉)进行了CEA。术前1周以内,对所有患者预手术侧颈总动脉远端、分叉处及颈内动脉近端进行了数字减影血管造影检查(DSA)及斜矢状位黑血MRI增强扫描(OB-CEMRI)。由2名放射科医师分别在DSA及OB-CEMRI图像上评价颈动脉(颈总动脉远端、分叉处及颈内动脉近端)最大狭窄部位、斑块破溃情况、最大狭窄程度、斑块累及范围,并将DSA、OB-CEMRI图像与CEA术后斑块病理切片图像进行对照,分别分析DSA和OB-CEMRI在显示上述评价指标方面的差异。结果 DSA(κ=0.807)和OB-CEMRI(κ=0.812)在判断颈动脉最大狭窄部位方面与病理图像均有较好的一致性。DSA诊断斑块破溃的敏感性为40.0%、特异性为66.7%,而OB-CEMRI的敏感性为90.0%、特异性为83.3%。在评价颈动脉管腔最大狭窄度方面,虽然DSA与OB-CEMRI无显著差异([77.33±3.79)%vs(76.02±3.95)%,P=0.648],但与病理图像比较,OB-CEMRI低估了管腔狭窄程度(P=0.008)。OB-CEMRI所显示的斑块累及范围18.96±4.96 mm更接近于病理(18.13±4.57 mm,P=0.506),明显大于DSA所显示的范围(14.80±3.78 mm,P=0.004)。结论作为一种无创的检查方法,OB-CEMRI可以较客观地评价粥样硬化颈动脉(颈总动脉远端、分叉处及颈内动脉近端)管腔最大狭窄部位、斑块破溃、斑块累及范围,但在评价管腔最大狭窄程度方面不如DSA准确,如果能在CEA术前联合使用OB-CEMRI和DSA对粥样硬化颈动脉进行检查,可为手术提供更加全面可靠的术前评估。     

颈动脉内膜切除术血管黏合重建的实验研究

目的：在颈动脉内膜切除术（CEA）中，应用黏合的方法进行血管重建，观察术后内膜的愈合过程。方法：采用血管内膜气体干燥损伤结合高脂饲料喂养2月的方法，在新西兰兔颈总动脉上复制粥样硬化性狭窄动物模型，在此模型基础上行颈动脉内膜切除术，运用超声、血管造影、病理等方法从影像学和组织学的角度观察比较CEA术后4h、1d、3d、7d、30d、90d等6个时间点内膜的愈合过程。结果：CEA术后内膜修复过程可以大体上分为血栓形成阶段，发生于术后数小时至3d左右；炎症反应阶段，与血栓形成几乎同时发生；内皮修复阶段，术后3d来自邻近的血管内皮细胞开始蔓延至内膜斑块切除段血管内面；血管平滑肌增值阶段，血管平滑肌细胞增殖开始于术后3d左右，发生在中膜的局部区域；基质形成、堆积阶段。结论：采用新型黏合血管重建的方法为颈动脉内膜切除术的血管重建提供了新的可靠手段。     

颈动脉内膜切除术治疗颈动脉狭窄8例临床分析

目的 :探讨应用颈动脉内膜切除术 (CEA )治疗颈动脉狭窄的临床疗效。方法:对 8例颈动脉狭窄患者行 CEA。手术全部采用全麻 ,术中放置动脉临时分流管。结果 :全组病例术后恢复顺利 ,无手术并发症发生。结论 :CEA是颈动脉狭窄的有效治疗方法。     

合并颈动脉狭窄的冠状动脉搭桥发生围手术期缺血性 脑卒中的常见因素分析

目的：分析同时合并有颈动脉疾病的冠心病患者围手术期发生缺血性脑卒中的常见因素,以提高对该类 疾病的治疗效果。方法：收集2008年至2014年厦门大学附属第一医院收治的44例多支冠状动脉病变合并颈动脉狭窄 的患者,其中男性32例,女性12例。所有患者在处理颈部病变后再接受冠状动脉旁路移植术。对其手术效果及随访 结果进行回顾性分析。结果：1例接受颈动脉内膜剥脱术的患者术后出现偏瘫,经治疗后临床症状改善。短暂性脑缺 血发作1例,5例患者在术后1周再发脑血管后循环梗死。12例患者术后48 h内出现神经损伤表现。早期使用主动脉内 球囊反搏9例,二次开胸止血1例,胸骨哆开3例;术后早期出现心房颤动27例。总计死亡2例。随访1~7年,随访率为 90%,44例患者脑缺血症状获得不同程度的改善。6例患者诉心绞痛症状再发,但复查冠状动脉造影或冠状动脉CT血 管造影无异常发现,随访期间1例患者因恶性肿瘤死亡。结论：接受冠状动脉搭桥手术的患者一旦合并颈动脉疾病, 其缺血性脑卒中发生的概率更高,但颈动脉狭窄并不是该类患者发生围手术期卒中的唯一原因,其他危险因素同样 不容忽视。     

Percutaneous transluminal stenting in patients with carotid artery stenosis

ObjectiveTo assess the efficacy and safety of percutaneous transluminal stenting for pati ents with carotid artery stenosis.Methods Selective percutaneous transluminal stenting was performed for patients with sym ptomatic carotid artery stenosis (luminal narrowing ≥70%). Success rates and c omplications associated with the procedures were observed. During six months of follow-up, both recurrent symptom and restenosis rates were recorded. Results There were 17 bifurcating lesions among 27 stenoses in 26 patients, of whom 18 had concomitant coronary artery diseases. The acute procedural success rate was 96.3% (26/27), and the degree of stenosis was reduced from 88.6%±8.9% （ran ge 70-100） to 0.4%±2.0% （range 0-10）. Six patients developed severe brady cardia and hypotension, and 3 experienced transient loss of consciousness during balloon dilatation. During hospitalization, 2 patients experienced loss of con sciousness and convulsion, respectively, due to hyperperfusion, and both recover ed 12 hours later. There were 2 minor stroke cases (7.4%) but no cases of majo r stroke or death. At the 6-month follow-up, there were no cases of TIA or ne w onset of stroke. There was no restenosis detected in 16 cases using angiograp hy and in 10 cases using MRI in 6 to 16 months of follow-up. Conclusions Percutaneous transluminal stenting for patients with carotid artery stenosis has a high procedural success rate with few and acceptable complications. Few pati ents suffered from recurrent symptoms or showed restenosis in long-term follow -up.     

Impact of carotid stenting in dizzy patients with carotid stenosis

BackgroundLittle is known about the impact of severe carotid stenosis on health-related quality of life (HRQoL). The aim of this study was to assess the effects of carotid stenting (CAS) on HRQoL in dizzy patients with carotid stenosis.MethodsPatients with symptomatic (≥60%) or asymptomatic (≥80%) severe carotid stenosis and who complained of dizziness and received CAS were recruited. Two HRQoL questionnaires—a generic survey, the 36-item Short-Form Health Survey and a disease-specific instrument, the Dizziness Handicap Inventory—served as outcome measures. Patients were followed 1 week prior to CAS and 6 months postprocedurally.ResultsCAS was performed in 178 consecutive patients, 61 of whom complained of dizziness. Forty-one patients (67.2%, 34 male; mean age, 73.3 ± 10.5 years; range, 47–87 years) completed the study. Twenty asymptomatic volunteers (17 male; mean age, 70.3 ± 9.3 years; range, 54–84 years) served as normal controls. Compared to controls, patients tallied lower scores in the overall total and three subscales (physical, functional, and emotional) of the Dizziness Handicap Inventory (p < 0.01). Similar findings were noted in seven out of eight domains of the 36-item Short-Form Health Survey score. After 6 months, CAS resulted in significantly improved HRQoL (role physical, bodily pain, general health, social function, and role emotional) in these patients.ConclusionCAS resulted in improved HRQoL in patients with severe carotid stenosis who experienced dizziness.     

颈动脉粥样硬化评分与缺血性卒中的诊断

目的：探讨颈动脉粥样硬化评分在缺血性卒中（ischemic stroke, IS）诊断的应用价值。方法： 选择经头颅CT或MRI确诊的缺血性卒中患者（病例组）151例进行回顾性分析,所有病例组患者在发病1周内完成颈动脉超声检查,同时按年龄和性别匹配151例健康体检者（对照组）, 所有对照组患者经CT或MRI排除缺血性卒中,并完成颈动脉超声检查。颈动脉斑块超声评价包括斑块的大小、部位、回声、质地及其表面是否规则;颈动脉粥样硬化超声评价包括动脉内-中膜厚度（intima-media thickness, IMT)、颈动脉狭窄程度、斑块数量及斑块评价。结果： 病例组与对照组患者IMT分别为（0.946±0.185） mm和（0.863±0.148） mm,差异有统计学意义（P<0.001）;颈动脉斑块参数中,与缺血性卒中相关的参数有斑块回声、斑块质地以及表面是否规则,而与斑块大小、斑块部位无相关性;病例组患者颈动脉斑块评分的中位数与四分位数间距分别为3和2,对照组分别为1和2,两者差异有统计学意义（P<0.001）。在颈动脉粥样硬化参数中,与缺血性卒中发生相关的指标是颈动脉斑块评分、颈动脉狭窄程度及IMT,而与斑块数量无相关性。病例组患者颈动脉粥样硬化评分的中位数与四分位数间距分别为5和4,对照组分别为2和4,两者差异有统计学意义（P<0.001）。IMT、颈动脉斑块数量、颈动脉斑块评分及颈动脉粥样硬化评分对诊断缺血性卒中的ROC曲线下面积分别为0.679、0.677、0.704和0.805（P<0.001）,颈动脉粥样硬化评分准确性最高。结论： 颈动脉斑块评分及颈动脉粥样硬化评分是缺血性卒中的诊断客观指标,且后者的准确性更高。     

二维彩色多普勒对颈动脉狭窄手术及介入治疗效果的评价

目的:探讨二维彩色多普勒超声在中-重度颈动脉狭窄患者外科手术及介入治疗前后的应用价值.方法:对27例中-重度颈动脉狭窄患者手术或介入治疗前后分别进行二维彩色多普勒检查,对颅外段颈动脉的形态学、血流动力学进行评价.结果:狭窄度为50%～70%的患者17例,71%～79%的患者2例,80%～89%的患者5例,90%～99%的患者3例.12例行颈动脉内膜剥除术(CEA)的患者术后7 d时,见颅外段颈动脉管腔通畅,血流速度接近正常,发现1例患者内膜残端漂浮于管腔中,但不影响血流方向及流速.15例行颈动脉经皮血管内支架成形术(PTAS)的患者术后2周见支架位置及走行均正常,管腔无明显狭窄.结论:二维彩色多普勒超声可以在CEA和颈动脉PTAS术前对颅外段颈动脉进行准确测量和正确评价,术后可对手术疗效进行随访观察和准确判断.