支架成形术治疗颈动脉狭窄的脑血流定量评价

Quantitative evaluation of cerebral blood flow by XeCT in stenting angioplasty for carotid artery stenosis

目的利用氙气CT(XeCT)技术分析颈动脉重度狭窄的血流动力学特点,并以此评价支架成形术的疗效。方法对13例颈动脉重度狭窄进行支架成形治疗,并利用XeCT进行血流定量评价。患者术前及术后1周分别接受XeCT检查,根据病变侧大脑皮层的脑血流值分为正常区、轻度缺血区、可逆性缺血区和梗死区,并按缺血面积大小作术前、术后对比。结果所有患者术前局部脑血流量均有不同程度降低,以大脑中动脉分布区最为显著;术后脑血流值有显著改善,轻度缺血区面积由32.63%变为14.22%,可逆性缺血区面积由13.54%变为8.38%,正常区域面积由47.51%变为71.13%,而梗死面积无显著变化。结论颈动脉重度狭窄时,脑组织存在易导致脑梗死的缺血区域,支架成形术治疗可明显改善患者的血流动力学障碍,其疗效可以通过定量的脑血流测定得到客观和准确的评价。

Objective To evaluate the hemodynamic characteristics of severe carotid artery stenosis and curative effect of stent angioplasty through XeCT. Methods From April 2006 to November 2006, 13 patients with severe carotid artery stenoses underwent stent angioplasty in our hospital, including 11 male and 2 females, in an average age of 57.31 ± 6.12. All patients underwent XeCT examination to evaluate the quantitative cerebral blood flow （CBF）. The ischemic cortex is categorized into 4 kinds, the normal region, oligemia area, reversible ischemic site and ischemic core center. Measurement and comparison of the changes were taken before and after the therapy. Results Preoperative XeCT revealed different decrease of CBF in the ipsilateral cortex, especially in MCA distributing territory. Ischemic areas reduced significantly after the stenting angioplasty. Oligemia area reduced from 32.63% to 14.22%. Reversible ischemic area reduced from 13.54% to 8.38%. Normal area increased from 47.51% to 71.13%. But ischemic core center showed no significant changes. Conclusions XeCT is beneficial for evaluation of the hemodynamic characteristics of carotid artery stenoses and also for accurately demonstrating the curative effects of the stent angioplasty. （J Intervent Radiol, 2007, 16： 295-298）