计算机断层扫描灌注成像对颈内动脉重度狭窄支架成形术的术前指导及术后评价

目的 探讨计算机断层扫描灌注成像（computer tomography perfusion，CTP）结合数字减影血管造影（digital subtraction angiography，DSA）对颈内动脉重度狭窄支架成形术的术前适应证选择及术后血流变化评价的作用。方法 40例经DSA检查提示单侧颈内动脉重度狭窄患者，按照DSA检查结果对缺血部位代偿良好的20例患者行保守治疗，代偿不良的20例患者行狭窄部位支架成形术，行CTP检查，比较非手术组及手术组基线和术后1年的CT相对灌注参数，并比较手术组基线、术后7 d、术后1年的手术侧和健侧的绝对灌注参数。结果 手术组基线相对脑血流量（relative cerebral blood flow，rCBF）明显较非手术组降低，相对脑血容量（relative cerebral blood volume，rCBV）升高（P分别为0.018和0.015），两组相对平均通过时间（relative mean transit time，rMTT）无差异，1年后手术组rMTT较非手术组低（P =0.012），rCBF、rCBV差异无统计学意义；与健侧相比，手术组术前患侧基线平均通过时间（mean transit time，MTT）延迟、脑血流量（cerebral blood flow，CBF）减低、脑血容量（cerebral blood volume，CBV）增高，术后7 d患侧MTT缩短、CBF明显增加、CBV回落，术后1年MTT、CBF、CBV患侧与健侧相比更加接近，两组比较尽管有统计学意义（P =0.015、0.012、0.037），但三个变量总体趋势逐渐接近；手术组术前、术后7 d、术后1年，不同时间点患侧与健侧绝对灌注参数变化有统计学意义（P =0.001，0.009，0.028）；支架成形与时间之间有交互作用（P =0.006，0.002，0.032）。结论 CTP结合DSA对颈动脉狭窄的患者合理选择手术适应证有一定指导作用。颈动脉支架成形术（carotid artery stenting，CAS）可以改善患者的脑血流状况。

Preoperative Guidance and Postoperative Evaluation in Patients with Severe Stenosis of Internal Carotid Artery before and after Stent Placement using Computer Tomography Perfusion Imaging

Objective To evaluate the computed tomography perfusion （CTP） imaging with digital subtraction angiography （DSA） in severe carotid artery stenosis before and after stenting and clinical evaluation ofhemodynamic changes, Methods Forty cases with DSA examinations showed severe unilateral internal carotid artery stenosis, CTP imaging was made. Twenty eases that DSA examinations showed good compensatory isehemia and blood flow in patients with no obvious delay were not made stents; the other 20 cases without a compensatory or compensation inadequate blood flow were made the stent surgery. The relative perfusion parameters of non-operative group and surgical group （including preoperative, postoperative 1 year） were carried out comparative analysis. To surgical group, absolute perfusion parameters of different periods （including preoperative, postoperative 7 days and after 1 year） were compared similarly.Results Two groups at the first time examination, relative mean transit time （rMTT）, relative cerebral blood flow （rCBF）, relative cerebral blood volume （rCBV） were compared, P=（0.471, 0.018, 0.015）, after 1 year comparison, P=（O.O 12, 0.132, 0.466）; Compared with the contralateral, ipsilateral surgery preoperative baseline mean transit time （MTT） delayed, cerebral blood flow （CBF） reduced, cerebral blood volume （CBV） increased, 7 days after surgery, ipsilateral MTT shortened, CBF increased significantly, CBV reduced, I year after surgery, MTT, CBF, CBV of both sides were more closed to each other. Even though the two groups were statistically significant （P=0.015, 0.012, 0.037）, the general trend of the three variables gradually approached; The changes of absolute perfusion parameters of both sides at different time points including before surgery, 7days and l year after surgery were significantly （P=0.001, 0.009, 0.028）; Between stent and time interacted eath other （P=-0.006, 0.002, 0.032）. Conclusion CTP can help select the surgical indications of severe internal carotid artery stenosis. Carotid artery stenting （CAS） can really improve patients with cerebral blood flow condition.