支架成形术治疗老年人颈动脉狭窄前后脑血流动力学评价

Evaluation of cerebral hemodynamics in geriatric carotid stenosis pre- and post-carotid artery stenting

目的探讨老年颈动脉狭窄相关局部脑血流量（rCBF）的影响因素，分析支架成形术前后脑血流灌注及相关临床症状的变化。方法回顾2005年8月至2008年4月我院行SPECT检查且经血管造影证实的老年颈动脉狭窄68例，分析颈动脉狭窄程度、狭窄侧别、是否合并椎基底动脉狭窄（VBS）、侧支循环是否开放和支架成形术前后等情况时相关rCBF的变化。结果单侧颈动脉狭窄按不同因素分组时相关rCBF下降例数的卡方检验：狭窄90％～99％分别与50％～69％和70％～89％患者比较，P值分别为0．046和0．020；合并VBS和不合并VBS患者比较，P值为0．927；侧支循环开放与无侧支循环患者比较，P值为0．222。颈动脉单侧狭窄与双侧狭窄患者比较，P值为0．046。支架成形术后狭窄相关的rCBF下降区76％的患者得到改善，神经功能状况的改良Rankin评分由入院时（1．4±0．7）分降为术后的（0．4±0．3）分（P〈0．001）。结论颈动脉狭窄程度、狭窄侧别可能是影响老年颈动脉狭窄相关rCBF的因素，支架成形术可明显改善狭窄相关rCBF，临床相关症状亦显著改善。

Objectives To explore influencing factors of regional cerebral blood flow （rCBF） in geriatric carotid stenosis, and to analyze changes of rCBF and clinical symptoms after carotid stenting. Methods During August 2005 and April 2008, 68 geriatric patients of carotid stenosis having SPECT examination in our hospital were retrospectively studied, whose diagnosis was approved by angiography. Correlated rCBF was compared separately in different stenotic degrees of carotid stenosis, in unilateral or bilateral stenosis, accompanied with vertebrobasilar stenosis （VBS） or not, with collateral circulation or not, before and after carotid stenting. Results When patients of unilateral carotid stenosis were grouped by different clinical factors, cases of patients with reduced rCBF were compared using X^2 test ： the P value was 0. 046 and 0. 020 when comparing group of stenotic degree 90% -99% with group 70% -89% and group 50%-69% ; the P value was 0. 927 between group accompanied with VBS and group without; the P value was 0. 222 between group with collateral circulation and group without. When comparing reduced rCBF cases between unilateral and bilateral carotid stenosis, the P value was 0. 046. After carotid stenting, 76% of patients had their rCBF improved, and also the scores of presenting symptoms evaluated by modified Rankin scale were elevated from 1.4 ± 0. 7 on admission to 0. 4 ± 0. 3 postoperatively （ P 〈 0. 001 ） . Conclusions The research indicates that higher stenotic degree and bilateral carotid stenosis may cause rCBF decrease in geriatric carotid stenosis. Carotid stenting may improve rCBF and change clinical symptoms significantly.