颈动脉超声造影联合经颅多普勒评估后循环缺血的初步研究

Evaluation of posterior circulation ischemia in combination with carotid contrast-enhanced ultrasound and transcranial Doppler:a preliminary study

目的颈动脉超声造影(CEUS)联合经颅多普勒超声(TCD)评估后循环缺血(PCI)患者的后循环血管病变。方法将155例PCI患者分为脑梗死组62例、短暂性脑缺血发作(TIA)组93例,均行颈动脉CEUS和TCD检测。同期设立健康对照组54名,用于确定TCD检查中的正常峰值流速。比较脑梗死组和TIA组斑块的稳定性、血流动力学异常和狭窄情况。结果①脑梗死组椎动脉颅外段所检出的斑块中,易损斑块占61.4%(51/83),高于TIA组的38.4%(38/99),差异有统计学意义,P<0.01。②脑梗死组的易损斑块的发生率为66.1%(41/62),高于TIA组的39.8%(37/93),差异有统计学意义,P<0.01。③脑梗死组后循环病变发生率为77.4%(48/62),高于TIA组的60.2%(56/93),差异有统计学意义,P<0.05。④脑梗死组后循环颅内段病变发生率为56.5%(35/62),高于TIA组的34.4%(32/93),差异有统计学意义,P<0.01。⑤脑梗死组后循环狭窄的发生率为27.4%(17/62),高于TIA组的11.8%(11/93),差异有统计学意义,P<0.05。结论动脉粥样硬化易损斑块形成是PCI,特别是后循环梗死的重要病因;联合颈动脉CEUS和TCD检测能快速、较准确评估PCI血管病变的分布。

Objective To evaluate posterior circulation vascular lesions in patients with posterior circulation ischemia （PCI） with carotid contrast-enhanced ultrasound （CEUS） and transeranial Doppler （TCD）. Methods A total of 155 patients with PCI were divided into an infarction group （n = 62） and a TIA group （ n = 93 ）. They were all underwent carotid CEUS and TCD examination. Fifty-four healthy subjects were selected as a control group to establish the normal peak velocity on TCD. The plaque characteristics, hemodynamic abnormalities, and stenosis of the infarction group and TIA group were compared. Results （1）Among the plaques detected from extracranial vertebral arteries, the vulnerable plaque was 61.4% （51/83） in cerebral infarction group. It was higher than 38.4% （38/99） in the TIA group. There was statistical significance （ P 〈 0. 01 ）. （2）The incidence of vulnerable plaque was 66. 1% （41/62） in the infarction group. It was significantly higher than 39.8% （37/93） in the TIA group. There was statistical significance （P 〈 0. 01 ）. （3）The incidence of posterior circulation lesions was 77.4% （48/62） in the infarction group. It was higher than 60. 2% （56/93） in the TIA group. There was statistical significance （ P 〈 0. 05 ）. （4）The incidence of lutracranial lesions of the posterior circulation in the infarction group was 56. 5% （35/62）. It was higher than 34.4% （32/93） in the TIA group. There was statistical significance （ P 〈 0. 01 ）. （5）The incidence of posterior circulation stenosis was 27.4% （17/62） in infarction group. It was higher than 11.8% （ 11/93 ） in the TIA group. There was statistical significance （ P 〈 0. 05 ）. Conclusion The formation of vulnerable plaque is an important cause of PCI, especially in the posterior circulation infarction. CEUS combined with TCD can quickly and accurately evaluate the distribution of PCI vascular lesions.