短暂性脑缺血发作的数字减影血管造影及颈部动脉超声评价

Evaluation of digital subtraction angiography and cervical artery ultrasound of transient ischemia attack

目的评价数字减影血管造影（digital subtraction angiography，DSA）和颈动脉超声对短暂性脑缺血发作（transient ischemi aattack，TIA）的诊断价值。方法74例TIA患者中，颈内动脉（internal carotid artery，ICA）系统TIA45例，椎基底动脉（vertebrobasil arartery，VBA）系统TIA29例，均行DSA检查以了解两系统颅内外动脉狭窄情况，行颈动脉超声检查以了解动脉斑块分布情况。结果DSA检查显示，ICA系统TIA患者血管狭窄检出率为84．4％（38例），重、中、轻度狭窄分别为31．1％（14例）、26．7％（12例）和11．1％（5例），其中颅内动脉狭窄为44．4％（20例），显著高于颅外动脉狭窄的22．2％（10例）（P〈0．001）；VBA系统TIA患者血管狭窄检出率为65．5％（19例），重、中、轻度狭窄分别为17．2％（5例）、27．5％（8例）、20．7％（6例），其中颅外动脉狭窄为44．8％（13例），显著高于颅内动脉狭窄的13．8％（4例）（P〈0．001）。颈动脉超声检查显示，ICA系统TIA患者ICA斑块检出率为44．4％（20例），高于VBA系统TIA患者的24．1％（7例）；VBA系统TIA患者锁骨下动脉起始段斑块检出率为44．8％（13例），显著高于ICA系统TIA患者的13．3％（6例）（P〈0．001）。结论ICA系统和VBA系统TIA患者颅内外血管病变和动脉硬化斑块分布存在差异，前者以颅内病变多见，后者则以颅外病变多见。

Objective To evaluate the diagnostic value of digital subtraction angiography （DSA） and carotid artery ultrasound for transient ischemia attack （TIA）. Methods Among the 74 patients with TIA, 45 had internal carotid artery （ICA）-TIA and 29 had vertebrobasilar artery （VBA）-TIA. DSA examination was performed in order to detect intracranial and extracranial arterial stenosis in the above two systems. Cervical artery ultrasound examination was used to understand the distribution of arterial plaques. Results DSA showed that the detection rate of vascular stenosis in patients with ICA-TIA was 84.4% （n =38）, and the patients with serious, moderate and slight stenoses were 31.1% （n = 14）, 26.7% （n = 12） and 11.1% （n = 5）, respectively. Of those, intracranial arterial stenosis was 44.4% （n = 20）, and it was significantly higher than 22.2% （n = 10） in extracranial arterial stenosis （P 〈 0. 001 ）; the detection rate of vascular stenosis in patients with VBA-TIA vcas 65.5% （n = 19）, and the patients with serious, moderate and slight stenoses were 17.2% （n = 5）, 27.5% （n = 8）, and 20.7% （n = 6）, respectively. Of those, extracranial arterial stenosis was 44. 8% （n = 13）, and it was significantly higher than 13.8% （n = 4） in intracranial stenosis （P 〈 0. 001 ）. Carotid artery ultrasound showed that the detection rate of ICA plaque was 44.4% （n = 20）, and it was higher than 24. 1% （n = 7） in patients with VBA-TIA; the detection rate of the plaques in the initial segment of subelavian artery in patients with VBA-TIA was 44.8% （n = 13）, and it was significantly higher than 13.3 % （n = 6） in patients with ICA-TIA （P 〈 0.001 ）. Conclusions There were differences between the intracranial and extracranial vascular lesions and the distribution of atherosclerotic plaques in patients with ICA-TIA and VBA-TIA. The former was more common in intracranial lesions, and the latter was more common in extracranial lesions.