颅内动脉狭窄经皮血管内支架成型术前后血流动力学改变与脑血管造影的对照研究

Comparative study on hemodynamic change of transcranial Doppler and digital subtraction angiography before and after percutaneous transluminal angioplasty and stenting in the patients with intracal stenosis artery

目的:通过经颅彩色多普勒对颅内动脉狭窄患者经皮血管内支架成型术前后血流动力学改变与脑血管造影的对照,评价经颅彩色多普勒在颅内动脉狭窄经皮血管内支架成型术中的价值。方法:58例颅内动脉狭窄的患者经皮血管内支架成型术治疗后,其病变血管的血流动力学多项指标(Vm,Vs,Vd,PI,RI)与治疗前进行比较。结果:51例患者与术前比Vs,Vm,Vd下降,PI值增高,RI值变化不大,经颅彩色多普勒及脑血管造影随访所有患者无再发狭窄;5例患者出现Vs,Vm,Vd增快,PI值增高,但均未见反流信号;2例出现Vs增快,Vm增快,Vd降低。中、重度狭窄经颅彩色多普勒与脑血管造影相符率较高,分别占89%,83%。结论:经颅彩色多普勒与脑血管造影均可作为经皮血管内支架成型术术前术后血流动力学改变的评价手段。

Objective To evaluate the value of transcranial Doppler to percutaneous transluminal angioplasty and stenting by compared with the hemodynamic change and digital subtraction angiography in intracal stenosis artery before and after the operation. Methods Fifty-eight patients with intracal arterial stenosis were compared all the indexes, including mean peak flow velocity, systolic peak flow velocity, end diastolic peak flow velocity, pulsatility index and resistance index of hemodynamics before and after the operation. Results Compared with preoperation, the indexes of mean peak flow velocity, systolic peak flow velocity and end diastolic peak flow velocity decreased in 51 cases while the pulsatility index increased, and resistance index had no change. All the cases were followed up with transcranial Doppler and digital subtraction angiography, and no restenosis occurred. The indexes of mean peak flow velocity, systolic peak flow velocity, end diastolic peak flow velocity, pulsatility index increased in 5 cases, no reflow signals were found. The indexes of mean peak flow velocity, systolic peak flow velocity increased while the end diastolic peak flow velocity reduced in 2 cases. The conformity rates which compared transcranial Doppler with digital subtraction angiography were higher in the moderate and severe stenosis, 89 % and 83 % respectively. Conclusion Transcranial Doppler and digital subtraction angiography can be used to evaluate hemodynamic changes before and after percutaneous transluminal angioplasty and stenting.