外伤性颈内动脉海绵窦瘘患者介入治疗的血液动力学分析

Observation of Hemodynamics in Patients with Traumatic Carotid-cavernous Fistula Interventional Therapy

目的应用经颅多普勒超声(TCD)观察外伤性颈内动脉海绵窦瘘(CCF)患者介入治疗(可脱式球囊栓塞术)前后的血液动力学变化。方法回顾分析2000年2月至2007年10月间介入治疗的18例外伤性CCF患者的TCD结果,并将手术前后的TCD与数字减影血管造影术(DSA)的检查结果进行比较。结果经DSA证实的18例CCF患者15例行可脱式球囊栓塞术,DSA证实手术一次成功;2例术中改为ICA闭塞术,术后DSA显示患侧ICA完全闭塞;另1例术中出现血管痉挛而被迫放弃手术。术前TCD检测:(1)17例患侧颈内动脉颅外段和(或)颈内动脉虹吸段血流速度加快,脉动指数(PI)值均减低,其中颈内动脉虹吸段加快者伴频谱紊乱。(2)10例患侧大脑中动脉(MCA)、16例患侧大脑前动脉(ACA)血流速度减慢伴PI值下降。(3)11例患侧大脑后动脉(PCA)、14例健侧ACA流速加快,频谱形态正常。(4)16例患侧、2例双侧眼上静脉(SOV)呈现反向的静脉动脉化频谱。术后1周及6个月后复查TCD显示,15例球囊栓塞患者术前异常的颈内动脉及SOV等血管的血液动力学参数均恢复或接近正常,2例行ICA闭塞术患者TCD显示患侧ICA完全闭塞(患侧大脑后动脉及健侧大脑前动脉流速加快)。结论TCD可以实时、动态的观察CCF患者颅内、外血管的血流及频谱改变,为临床提供可靠的血液动力学信息。

Objective To observe hemodynamic changes by using Transcranial Doppler(TCD) in patients with traumatic carotid-cavernous fi stula(TCCF) before and after the interventional therapy(detachable balloon embolization). Methods We retrospectively analyzed(from Feb 2000 to Oct 2007) the TCD results of 18 patients with TCCF before and after the operation and compared with the digital subtraction angiography(DSA) results. Results Of all the patients diagnosed TCCF through DSA before the operation, 15 patients underwent detachable balloon embolization and DSA conf irmed a successful surgery; 2 patients had to be changed to the affected internal carotid artery (ICA) occlusion and DSA images displayed the affected ICA complete occlusion; one patient was forced to give up any operation for the vascular spasm. Before the treatment, the results showed a group of characteristic hemodynamic changes: (1) The higher velocity of blood ? ow and the lower pulsatility index (PI) in the extracranial segment and/or the siphonic segment of ICA were showed in 17 patients and the spectra of the siphonic segment of the affected ICA disordered. (2)The velocity of blood flow and PI were reduced in 10 patients of the affected middle cerebral artery (MCA) and 16 patients of the anterior cerebral artery (ACA). (3)The velocity of blood ? ow was accelerated with normal spectra in 11 patients of the affected posterior cerebral artery (PCA) and 14 patients of the contralateral ACA. (4) The blood flow of the superior ophthalmic vein (SOV) was reversed and its abnormal frequency spectra showed arterializational manifestation of the affected in 16 patients and of bilateral in 2 patients. Seventeen patients were followed up with TCD at 1 week and 6 months. The abnormal hemodynamics of ICA and SOV in 15 patients were recovered or approached normally after detachable balloon embolization. The TCD in 2 patients after ICA occlusion showed the affected ICA complete occlusion (high velocity of blood flow of the affected PCA and the contralateral ACA). Conclusion TCD provides a dynamic and real-time observation of the blood flow in the intracranial and extracranial blood vessels accurately, and also provides reliable hemodynamic data for CCF in clinical diagnosis and treatment.