超声在缺血性脑血管病介入治疗中的诊断价值

目的：探讨彩色多普勒超声（CDI）、经颅多普勒超声（TCD）对缺血性脑血管病的诊断及在脑血管成形支架植入术后随访中的价值，并与全脑数字减影血管造影（DSA）比较。方法：对261例缺血性脑血管病患者行颈部血管听诊、CDI、TCD检查，其中175例加行DSA检查，对有手术指征49例患者行脑血管成形支架植入术并随访。结果：①CDI证实颅外段脑血管狭窄〉50％的患者血管杂音的阳性率高达82％。TCD提示颅内段脑血管狭窄患者血管杂音阳性率达50％。②CDI及TCD示颅外段颈、椎动脉狭窄〉50％的患者中DSA符合率达82％；TCD提示颈内动脉虹吸段或大脉中动脉狭窄〉50％的患者中DSA符合率达98％。③脑血管成形支架植入术后患者CDI可清楚显示支架位置形态及支架内膜增生情况。CDI及TCD在术后监测发现狭窄段血流速度较术前明显降低；而术后支架内再狭窄的发生则表现为血流速度的再度增快。结论：CDI、TCD联合应用对缺血性脑血管病介入治疗前的诊断及术后随访提供了一种可靠的无创性综合检查方法。

Value of Ultrasound in the Interventional Therapy of Ischemic Cerebrovascular Disease

Objective: To investigate the diagnostic values of color Doppler imaging(CDI) and transcranial Doppler(TCD) on ischemic cerebral diseases caused by stenosis of cerebral arteries and their values on follow-up after stent placement and compare to DSA.Methods:A total of 261 cases of cerebral arterial stenosis with the formation of plaque diagnosed by CDI or TCD were examined with auscultation and 175 of them were examined with DSA.Those patients with surgical indications were treated with stent placement and followed up after surgery.Results: The positive rate of vascular murmur was 82% in the patients who were diagnosed as extracranial cerebrovascular stenosis(>50%) with CDI;The positive rate of vascular murmur was 50% in the patients diagnosed as encephalic cerebral arterial stenosis with TCD.In the patients with >50% stenosis of extracranial carotid or vertebrate arteries found by TCD and CDI,82% of them were proved to be positive by DSA.In the patients with >50% stenosis of ICA siphon segment or MCA found by TCD,98% of them were diagnosed as positive by DSA.CDI after stent placement could clearly revealed the position of the stent and the endomembrane hyperplasia in the stent.TCD and CDI indicated that the velocity on the stenosis position was decreased after the stent placement.When the velocity was increased again,it was due to the restenosis.Conclusion: The combination of CDI and TCD may be a reliable non-invasive way for the diagnosis before interventional procedures and follow-up after the surgery.