颅外段颈动脉狭窄支架植入术前后颅内外血流动力学变化的研究

目的 研究颅外段颈内动脉（EICA）狭窄支架植入术（CAS）治疗前后颅内、外动脉血流动力学的变化.方法 用彩色多普勒血流显像（CDFI）和经颅彩色多普勒血流显像（TCCD）分别对38例EICA狭窄患者CAS治疗前、后狭窄局部管径、收缩期峰值流速（PSV）及同侧大脑中动脉、眼动脉PSV、搏动指数（PI）和颅内侧支循环的建立情况进行分析.结果 CAS术后患侧原狭窄处内径较术前明显增宽（P＜0.001）,仍小于对侧（P＜0.001）;PSV较术前明显降低（P＜0.001）,仍大于对侧（P＜0.05）.CAS术后患侧大脑中动脉、眼动脉的PSV、PI较术前明显增高（P＜0.001）,与对侧比较差异无统计学意义（P＞0.05）.侧支循环全部关闭.结论 CDFI与TCCD结合可评价CAS治疗前、后颅内、外动脉的血流动力学变化,对判断CAS疗效具有重要的临床价值.CAS是治疗EICA狭窄安全而有效的方法,短期疗效令人满意.

Extracranial and intracranial hemodynamic changes before and after carotid artery stenting

Objective To study the extracranial and intracranial arterial hemodynamic changes before and after carotid artery stenting(CAS). Methods Thirty-eight patients with extracranial internal carotid arterial(EICA) stenosis were selected.Before and after CAS, the vessel diameter,the peak systolic velocity(PSV) in bilateral EICA and the PSV, pulsatility index(PI) in bilateral middle cerebral artery(MCA),ophthalmic artery(OA) were measured respectively by color Doppler flow imaging(CDFI) and transcranial color-coded duplex sonography(TCCD).Results Compared with pre-CAS,the diameter of ipsilateral EICA showed obviously increase post-CAS(P< 0.001 ) though it was significantly lower than that of contralateral side(P< 0.001 ).The PSV of ipsilateral EICA after CAS decreased significantly compared with that before CAS(P< 0.001 ) but it was higher than that of contralateral side(P< 0.05 ).The PSV and PI of ipsilateral MCA and OA after CAS showed obviously increase compared with those before CAS(P< 0.001 ),and there was no significant difference between bilateral MCA and OA(P> 0.05 ).The established collateral circulation were closed. Conclusions The extracranial and intracranial arterial hemodynamic data measured by CDFI and TCCD are valuable in evaluation of CAS.CAS is an effective and safe treatment for carotid stenosis,and the long time follow-up remains to be.