经颅多普勒超声对椎基底动脉狭窄经皮腔内血管成形术后脑血流灌注的评估价值

Value of Transcranial Doppler in the Evaluation of Cerebral Blood Flow in Patients with Vertebrobasilar Artery Stenosis after Percutaneous Transluminal Angioplasty

目的探讨经颅多普勒超声(TCD)对椎基底动脉狭窄患者经皮腔内血管成形术(PTA)手术前后脑血流灌注的评估价值。方法选取2011年2月—2012年2月在沧州市中心医院神经内科住院的43例经数字减影血管造影(DSA)确诊的椎基底动脉重度狭窄患者,PTA治疗前后对双侧椎动脉和基底动脉行TCD检查,收集各项血流参数〔收缩期血流速度(Vs)、舒张期血流速度(Vd)、搏动指数(PI)、阻力指数(RI)〕进行比较分析,并与DSA血管形态学结果进行综合比较。结果术前42例患者TCD检查病变动脉血流速度增快,频谱分布紊乱,频窗填充,可见涡流信号,RI及PI增高,闻及粗糙血管杂音或鸥鸣音;1例起始部未探及确切血流信号。TCD检查异常率为97.6%,其中基底动脉血流速度异常6例,单侧椎动脉血流速度异常28例,双侧椎动脉血流速度异常8例,基本正常1例。术后42例患者病变动脉血流各项参数恢复至参考范围,双侧对比基本对称,血流频谱形态正常,频窗清晰,血流音频信号正常;1例变化不大。PTA手术前后TCD各项血流参数比较,差异均有统计学意义(P<0.05)。术前TCD与DSA结果相符率为97.6%;术后6个月随访所有患者无再发狭窄。结论 TCD可以为PTA治疗椎基底动脉狭窄前后的疗效评价和术后随访提供客观依据,结合DSA结果可清楚了解脑缺血改善之后各项血流参数的相应改变。

Objective To discuss the value of transcranial Doppler （TCD） in the evaluation of cerebral blood flow in patients with vertebrobasilar artery stenosis before and after percutaneous transluminal angioplasty （PTA） . Methods 43 pa- tients with vertebrobasilar artery stenosis diagnosed by digital subtraction angiography （DSA） were given TCD ultrasonography be- fore and after PTA treatment. Blood flow indicators （Vs, Vd, PI and RI） were collected and compared with vascular morphology results of DSA. Results Before PTA, TCD examination showed that the blood flow velocity in artery with stenosis was increased with spectrum disorders, the frequency window was filled and eddy current signal could be seen, meanwhile, the RI and PI were increased and coarse vascular murmur or gull sound could be heard; blood flow signal was not detected in the initial part in one case. The abnormality rate according to TCD was 97.6%, among which 6 cases had abnormal blood flow velocity in basilar artery, 28 cases in unilateral vertebral artery, 8 cases in bilateral vertebral artery and one case had normal velocity. After PTA, the spec- trum was normal with clear frequency window, and the blood audio signal was also normal ; one case had little change. The blood flow indicators according to TCD showed statistically significant differences before and after PTA （P 〈 0. 05 ） . All the indicators had decreased to reference range. The consistent rate between TCD and DSA before PTA was 97.6%. No patient had recurrence of stenosis during the six - month following up. Conclusion TCD can provide objective evidence for evaluation of the effects before and after PTA in the treatment of vertebrobasilar artery stenosis and for the follow - up visit after PTA. Combined with the results of DSA, corresponding changes after the improvement of cerebral ischemia can be clearly known.