症状性颅内动脉狭窄介入治疗前的影像评估

Preoperative imaging evaluation of interventional therapy for patients with symptomatic intracranial artery stenosis

目的探讨症状性颅内动脉狭窄介入治疗前影像评估对介入治疗适应证选择的指导价值。方法26例颅内动脉狭窄患者，介入治疗前全部行DSA、高分辨率MRI斑块成像、CT或MR灌注成像，分别对脑供血动脉、动脉狭窄程度和斑块性质及成分、脑血流灌注情况等进行评价。对动脉粥样硬化性狭窄的患者，根据高分辨MRI表现分析斑块性质，对不稳定性斑块患者行介入治疗；而对动脉炎性狭窄的患者则采用药物治疗。随访观察有无再发缺血性脑卒中事件。结果18例患者MRI表现为血管偏心狭窄、病灶轻度强化或不强化，DSA表现为Mori B型或C型病变，判断狭窄由动脉粥样硬化斑块引起。这18例中13例为不稳定斑块；1例为稳定斑块伴灌注失代偿，给予颅内支架成形术；其余4例稳定斑块引起狭窄患者采用药物治疗。8例狭窄由动脉炎引起，MRI显示狭窄病变处内膜向心性增厚和环形强化，采取内科保守治疗。本组患者随访1．0～8．0个月，中位时间6．0个月，平均（5．2±3．1）个月，未再出现狭窄病变相关性短暂性脑缺血发作（TIA）或脑卒中。结论症状性颅内动脉狭窄患者治疗前进行综合影像评估，对于指导临床制定治疗方案具有重要价值。

Objective To investigate the value of comprehensive preoperative imaging evaluation in determining indication of intervention for patients with symptomatic intracranial artery stenosis. Methods DSA, high-resolutlon MRI of plaque and computed tomography perfusion （CTP） or perfusion weighted imaging （PWI） were performed in 26 patients with symptomatic intracranial artery stenosis and the intracranial artery cavity, artery wall and cerebral perfusion were evaluated. For patients with atherosclerotic plaque, the plaque characterization was analyzed according to high-resolution MRI findings, and intervention was used for those with unstable plaque. However, medicine was used for patients with arteritis. All patients were followed up after therapy. Results Combining with DSA, the stenosis in 18 cases was thought to be associated with atheroselerotic plaque, which showed eccentric stenosis with mild or no enhancement on MRI; 13 of them had symptomatic unstable plaques, 1 case showed stable plaque but cerebral perfusion damaged severely, all of them were treated with interventional therapy ; the other 4 cases had stable plaques and treated with medicine. The stenosis in 8 patients, which showed concentric hypertrophy of local endangium on MRI, was caused by arteritis and treated with medicine. No ischemic events occurred during the following 1--8 months [ average （ 5.2 ＋ 3. 1 ） months ] after therapy. Conclusion Comprehensive preoperative imaging evaluation for patients with symptomatic intracranial artery stenosis is of great value in guiding the therapy.