单侧颈内动脉狭窄患者支架置入前后脑血管储备能力变化分析

目的应用经颅多普勒超声（TCD）评价单侧重度颈内动脉狭窄患者支架置入前后对脑血管储备能力（ CVR）影响。方法经确诊单侧颈内动脉重度狭窄（＞70％）患者79例，将侧支循环开放分为前交通动脉（ACoA）、后交通动脉（PCoA）及颈内-外动脉（ICA - ECA）开放，比较不同侧支循环开放类型患者在颈内动脉支架置入术前与术后颅内血管血流及 CVR 变化。结果TCD 显示术后患侧大脑中动脉收缩期峰值血流速度、搏动指数及 CVR 明显高于术前，差异有统计学意义（P ＜0.05），颈内动脉狭窄患侧的 CVR 按照不同侧枝循环开放类型从高到低依次为：ACoA ＋ PCoA ＋ ICA - ECA ＞ ACoA ＋ ICA - ECA ＞ ACoA ＞ ACoA ＋ PCoA＞ PCoA ＋ ICA - ECA ＞ PCoA ＞ ICA - ECA，支架术后 CVR 均恢复正常范围，不同侧枝循环开放患者的差异无统计学意义（P ＞0.05）。结论应用 TCD 可以检测颈内动脉重度狭窄患者颅内血流变化，观察不同侧枝循环开放患者支架置入前后 CVR 改变，为颈内动脉支架置入治疗和评估提供可靠的依据。

Analysis of cerebrovascular reserve capacity in patients with unilateral internal carotid stenosis before and after stent implantation

Objective To evaluate using transcranial Doppler ultrasound(TCD). Methods Seventy-nine patients were diagnosed as unilateral internal carotid artery stenosis( > 70% ). The collateral circulation was divided into anterior communicating artery(ACoA), posterior communicating artery(PCoA)and internal carotid artery type(ICA-ECA). Then the cerebrovascular reserve(CVR)capacity and intracranial blood flow in patients with unilateral severe internal carotid artery stenosis before and after stent insertion were compared. Results TCD showed that postoperative ipsilateral middle cerebral artery peak systolic velocity,pulsatility index and CVR were significantly higher than those before operation,and the difference was statistically significant(P < 0. 05). Stenosis of internal carotid artery of the affected side of the CVR in accordance with different collateral types from high to low was as follows:anterior communicating artery(ACoA)+ traffic artery type(PCoA)+ internal-external carotid artery type ICA - ECA > ACoA + ICA - ECA > ACoA > ACoA + PCoA > PCoA + ICA - ECA > PCoA >ICA - ECA,and stenting after CVR was recovered to normal range,and there was no significant difference between different collateral circu-lation in patients. Conclusion TCD can detect the intracranial blood flow changes of internal carotid artery in patients with severe stenosis, and observe CVR before and after different collateral circulation in patients with open stent placement change,so it provides a reliable basis for the treatment and evaluation of internal carotid artery stent placement.