132例缺血性脑血管病患者DSA分析

Analysis of DSA for ischemic cerebrovascular disease:A report of 132 cases

目的采用经颅多普勒(TCD)进行缺血性脑血管病(ICVD)筛查,并与DSA检查进行对比研究,以了解TCD在诊断缺血性脑血管病中的价值,同时分析缺血性脑血管病患者颅内外动脉狭窄或闭塞发生的特点。方法回顾性分析132例诊断为缺血性脑血管病的患者,先有21例患者同时行DSA及TCD检查,进行对比研究。另有111例ICVD患者行DSA检查,明确有无脑供血动脉的狭窄或闭塞及其位置,判断责任血管。结果与DSA结果相比较,TCD特异性为98.5%,敏感性为61.9%。132例ICVD患者中发现脑供血动脉狭窄或闭塞85例(64.4%),烟雾病9例(6.8%),动脉瘤5例(3.8%),1例颈内动脉海绵窦瘘,1例颈内动脉起始部狭窄合并另一侧颈内动脉起始部夹层,可判断责任血管68例(68.0%),脑梗死组的脑供血动脉狭窄或闭塞发生率高于短暂性脑缺血发作(TIA)组(P<0.05),脑梗死患者中颅内病变多于颅外病变(P<0.05),而TIA患者颅内外病变发生率差异无统计学意义。结论 TCD可作为筛查缺血性脑血病的常用方法,特异性高,但敏感性一般。中国人缺血性脑血管病患者中,脑梗死颅内动脉病变发生率高于颅外动脉,但在TIA患者中,差异无统计学意义。

Objective Through comparison between transcranial Doppler ultrasound（TCD） and digital subtraction angiography（DSA）,to investigate the diagnostic value of TCD in the ischemic cerebrovascular disease（ICVD）,furthermore,investigate the angiographic characteristics of cerebral arterial stenosis or occlusion in patients with IVCD.Methods Twenty-one patients underwent TCD and DSA examinations.One hundred and eleven patients were examined by cerebral DSA.The inspection results were reviewed by experienced physicians.When any cerebral arterial stenosis or occlusion was demonstrated,its severity degree,location,guilty artery with its length were identified and measured.Results Of 132 cases with ICVD,cerebral arterial stenosis or occlusion was found in 85 cases（64.4%）,moyamoya disease was found in 9 cases（6.8%）,aneurysm was found in 5 cases（3.8%）,cavernous sinus fistula was found in 1 case,internal carotid artery dissection was found in 1 case,amidst which the guilty artery could be identified in 68 cases（68.0%）.The occurrence of cerebral arterial stenosis or occlusion was more frequently seen in cerebral infarction group than in TIA group（P0.05）.The occurrence of intracranial arterial stenosis or occlusion was more frequently seen than that of extracranial in cerebral infarction group（P0.05）.While,no significant difference in TIA group between the intracranial and extracranial stenosis or occlusion（P0.05）.Conclusion TCD has been proved to be a valid method of screening in the ischemic cerebrovascular disease.The occurrence of intracranial arterial stenosis or occlusion was more frequently seen in Chinese cerebral infarction patients.