血管内超声在颈动脉蹼诊疗中的应用

目的探讨血管内超声(IVUS)在颈动脉蹼诊断和治疗中的应用价值。方法2019年1月武汉大学中南医院收治1例男性29岁缺血性脑卒中患者,CTA和高分辨MRI证实右侧颈内动脉起始部颈动脉蹼,采用IVUS技术进一步评估颈动脉蹼形态特征、颈动脉血流状态,并指导支架成形术。结果术中IVUS提示颈动脉蹼呈一与管壁相连的条带状低回声信号影,将管腔血流分隔,其后方血流瘀滞、对比剂滞留;虚拟组织学(VH)成像(iMap-IVUS)提示该结构以纤维组织成分为主,其背面可见部分坏死组织。支架植入术后IVUS、DSA提示支架贴壁良好,颈动脉蹼消失,未见血液湍流及对比剂滞留。结论IVUS技术可对颈动脉蹼进行全面评估,在探索颈动脉蹼致脑卒中机制和指导介入治疗中起着重要作用。

The clinical application of intravascular ultrasound in diagnosing and treating carotid web

Objective To discuss the application value of intravascular ultrasound(IVUS)in diagnosing and treating carotid web.Methods A 29-year-old male patient with ischemic stroke was admitted to the Zhongnan Hospital of Wuhan University of China in January 2019.CT angiography and high-resolution MRI proved the diagnosis of carotid web located at the origin of right internal carotid.IVUS was performed to make a further evaluation of the morphological characteristics of carotid web and the blood flow state of carotid artery,and to guide the performance of stenting angioplasty of carotid artery.Results Intraoperative IVUS demonstrated that carotid web was characterized by a strip-shaped hypoechoic signal shadow connected to the vascular wall,which separated vascular lumen blood flow.Blood flow stagnation and contrast agent retention were observed behind the carotid web.Virtual histology(VH)imaging(iMap-IVUS)indicated that the web was mainly composed of fibrous tissue with partial necrotic tissue on its back.After stent implantation,IVUS and DSA revealed that the stent was well stuck on the wall of the carotid artery,the carotid web disappeared,and no blood turbulence or contrast agent retention was detected.Conclusion IVUS can comprehensively evaluate the morphological features of carotid web,which plays an important role in exploring the mechanism of cerebral apoplexy caused by carotid web and in guiding interventional treatment.