颈动脉狭窄的超声、影像学及手术所见分析

Analysis of Ultrasound, other Imaging Technology and Surgical findings in Patients with Carotid Artery Stenosis

观察颈部动脉狭窄程度、病变性质和颅内侧枝循环建立，比较无创检查和有创检查所见，及其与脑梗塞发生的关系。用经颅多普勒、彩超、血管造影、头颅ＣＴ或核磁共振检查患者，确定颈部血管狭窄部位、程度、性质，以及颅内血管受累和颅内侧枝循环建立情况，并进行颈动脉内膜剥脱术。共收集患者８例。血管造影发现血管狭窄单侧５例，双侧３例，其中５例同时有多条血管狭窄。超声发现血管狭窄呈低回声或混合回声。在术前出现脑梗塞３例。与血管造影比较，彩超容易低估高度狭窄血管的狭窄程度，但是对轻度狭窄和局部斑块形成，血管造影容易漏诊。同时观察颅内血管狭窄和侧枝循环情况有助于判断预后和决定治疗方案。对高度狭窄、颅内侧枝循环不健全以及颈部血管狭窄部位的低回声或混杂回声的患者应及时手术，以免发展成脑梗塞。

To evaluate the degree of stenosis and pathology of the lesion and intracranial collateral circulation in the patients of carotid stenosis who underwent endarterectomy. Eight cases were collected. All of them were screened with color duplex, TCD, DSA, brain CT and MRI, then endarterectomy and gross pathologic examination were performed. The prognosis of patients was predicted according to the grade of stenosis, echo quanlity, intracranial involvement and collateral circulation. Carotid artery involvment was unilateral in 5 cases, bilateral in 3 cases and multiple, including carotid, subclavian and intracranial arteries, in 5 cases. The color duplex underestimated the degree of stenosis in cases of high grade stenosis, but the DSA could not show low grade stenosis and small plaque, which were clearly demonstrated in the duplex, especially in the crossed section. The pathology showed athrosclerosis in all the 8 cases. Three cases developed to cerebral infarction before the operation, in whom, high grade stenosis, poor intracranial collateral circulation, low or mixed echo quality, new thrombosis or fibrosis mixed with new bleeding and clot were discovered. The patients with this findings should be performed endarterectomy as soon as possible so as to avoid cerebral infarction. [WT5”HZ〗