腔内超声对颈动脉支架成形术的评估

Intravascular ultrasound assessment of carotid artery stenting

目的评估血管腔内超声(IVUS)在颈动脉狭窄血管内支架成形术中的应用价值。方法应用IVUS对18例颈动脉狭窄患者进行颈动脉内壁病变判断,指导支架置入并观察血管内支架置入前后血管形态学改变。并以8个正常患者的颈动脉管壁IVUS图像作为对照组。结果IVUS清晰显示血管壁的形态结构,精确测量血管狭窄程度。本组18例均接受血管内支架成形手术,成功置入支架18枚;经6-52个月随访(平均28个月),除2例于术后30d内TIA发作外,无一例脑梗死和再狭窄发生。结论IVUS比DSA更精确判断颈动脉病变性质、狭窄程度以及血管内支架术后的管腔变化,指导选择合适的球囊扩张管腔。IVUS引导支架置入可能有效预防再狭窄的发生。

Objective To evaluate the role of Intravascular ultrasound（IVUS） in the diagnosis and treatment of carotid stenosis with carotid stenting. Methods IVUS were used to examine 18 patients with carotid stenosis, and to explore morphological changes of carotid pre-stenting and post-stenting according to extent of pathological changes. Normal IVUS images of eight carotid arteries were compared as control group. Results Morphological configuration of carotid artery could be revealed and areas both of plaque and lumen could be measured accurately. 18 patients were treated successfully by stenting with no recurrence of stroke and restenosis at follow-up 6-52 months （ mean： 28 months）. Conclusion IVUS can clearly show the characteristic of atherosclerosis of carotid artery, and provide precise measurement of severity of stenosis. IVUS can also evaluate the changes of the arterial wall and lumen after stent planting more accurately than DSA, and guide to expand vascular cavity with balloon more effectively. Carotid stenting guided by IVUS may prevent restenosis effectually.