经颅多普勒超声检测单侧颈动脉重度狭窄患者血管内支架成形术前后脑血管储备能力的变化

Detecting the changes of cerebrovascular reserve capacity with transcranial Doppler ultrasonography in patients with unilateral high-grade carotid stenosis before and after angioplasty and stenting

目的探讨有症状单侧颈动脉重度狭窄患者血管内支架成形术(CAS)前后脑血管储备能力的变化。方法采用经颅多普勒超声(TCD)检测屏气引起的高碳酸血症对大脑中动脉血流速度的影响。比较15例有症状单侧颈动脉重度狭窄患者(有症状组)、15例无症状颈动脉狭窄患者(无症状组)和10名正常对照者(对照组)的屏气指数(BH I),并比较有症状组患者在CAS前后BH I的变化。利用BH I评估脑血管储备能力。结果有症状组狭窄侧BH I(0.5±0.2),明显低于无症状组狭窄侧(0.9±0.3,P<0.001)和对照组(1.1±0.3,P<0.001),而有症状组正常侧BH I(0.9±0.3)与无症状组正常侧(1.1±0.2)及对照组(1.1±0.3)比较差异无显著性(P>0.05)。术后有症状组患者CAS狭窄侧BH I(1.1±0.2,P<0.001),而正常侧BH I未见明显改变(P>0.05)。结论有症状单侧颈动脉重度狭窄患者狭窄侧脑血管储备能力明显受损,CAS后显著改善。

Objective To explore the changes of cerebrovascular reserve capacity in patients with symptomatic unilateral high-grade carotid stenosis before and after angioplasty and stenting （CAS）. Methods The cerebrovascular reserve capability was evaluated with transcranial Doppler （TCD） ultrasonography for hypercapnia induced by breath holding, which affected the blood velocity in middle cerebral artery. The breath-holding index （BHI） in 15 symptomatic patients with unilateral severe carotid stenosis and 15 asymptomatic patients with carotid stenosis and lO normal controls were compared, and the changes of the BHI in 15 symptomatic patients with carotid stenosis before and after CAS were compared and analyzed. Results The BHI of the stenotic side in symptomatic patients with unilateral carotid stenosis （0. 5 ± 0. 2 ） was significantly lower than that in asymptomatic patients with carotid stenosis （ 0. 9 ± 0. 3, P 〈0. 001 ） and normal controls （ 1.1 ± 0. 3, P 〈 0. 001 ） ; and there were no significant differences between the BHI of the unaffected side in symptomatic patients with unilateral carotid stenosis （ 0. 9 ± 0. 3 ） and the unaffected side in asymptomatic patients with carotid stenosis （ 1.1 ± 0. 2 ） and in normal controls （ 1.1 ± 0. 3, P 〉 0. 05）. The BHI of the stenotic side in symptomatic patients with unilateral carotid steno-sis improved significantly after CAS （1.1 ± 0. 2, P 〈0. 001 ） as compared with before operation , howev- er, there was no significant change in the BHI of the unaffected side （ P 〉 0.05 ）. Conclusion The significantly impaired cerebrovascular reserve capacity on the stenotic side in symptomatic patients with unilateral high-grade carotid stenosis was significantly improved after CAS.