彩色多普勒血流显像在颈动脉狭窄患者支架置入术后随访中的应用

Application of color Doppler flow imaging in the follow up study of patients with carotid stenosis after stenting

目的 应用彩色多普勒血流显像（CDFI）观察颈动脉狭窄患者颈动脉支架置入术（CAS）后局部血管内径及血流速度的变化.方法 纳入术前行CDFI和DSA检查的缺血性脑血管病患者76例,对其中40例符合手术标准的中重度狭窄患者行CAS.术后3 d,1、3、6、12及24个月应用CDFI检测支架近心段、中段、远心段的内径和收缩期峰值血流速度（PSV）,并与DSA结果相比较.CAS后≥6个月,PSV≥155 cm/s的患者立即复查DSA,PSV正常的患者6个月后复查DSA.结果 ①40例CAS技术成功率为100%,1例（2.5%）死亡,2例失访,37例获得24个月随访,1例发生再狭窄（狭窄率为50%~69%）,再狭窄发生率为2.7%.②CAS后各时间点支架中段内径较术前明显改善,差异均有统计学意义（P〈0.05）.CAS后随时间延长,支架各段内径均逐渐增加,术后1~3个月增幅最明显,6、12及24个月支架各段内径与前一阶段比较差异均无统计学意义（P〉0.05）,提示支架形态渐趋稳定.③CAS后各时间点支架各段PSV较术前明显改善,且均在正常范围内.④术前行CDFI和DSA检查的76例患者,两种方法诊断狭窄程度符合的有74例,其中2例DSA诊断为重度狭窄,CDFI诊断1例为中度狭窄,1例为闭塞.符合率为97.4%.术后≥6个月,共20例行DSA检查,CDFI与DSA均显示为轻度狭窄的有19例,中度狭窄的有1例.符合率为100%.结论 应用CDFI动态监测CAS后支架各段管径及血流的改变,有助于发现支架内再狭窄.与DSA比较,其检查结果可靠.

Objective To observe the changes of local lumen diameters and flow velocity in patients with carotid artery stenosis after stenting with color Doppler flow imaging （CDFI）. Methods Seventy-six patients with ischemic eerebrovascular disease conformed by CDFI and Digital Subtraction Angiography （DSA） were enrolled . 40 of them with moderate to severe stenosis were performed carotid artery stenting （CAS）. The proximal, middle, and distal lumen diameters of the stents and the peak systolic velocity （PSV） were detected with CDFI at day 3, 1, 3, 6, 12, and 24 months after procedure, and they were compared with the results of DSA. At t〉 6 months after CAS, the patients with PSV /〉 155 cm/s were un- derwent DSA reexamination immediately. The patients with normal PSV were reexamined with DSA after 6 months. Results ①The success rate of CAS in 40 patients were 100% , 1 patient （2.5%） died, and 2 were lost to follow-up. Thirty-seven patients completed 24-month follow up study, 1 had restenosis . ②After CAS, the lumen diameter of middle segment of stents were improved significantly than those before proce- dure at each time point. The differences were statistically significant （ P 〈 0.05 ）. After CAS, the lumen di- ameters of all segments increased gradually, and most obviously at 1 to 3 months after procedure. Therewere no significant differences in the lumen diameters of all segments at 6, 12, and 24 months （P 〉 0. 05 ） , suggesting the stents were stable gradually. ③ The PSV of each stent segment at all time points af- ter CAS were improved more significantly than that before procedure, and all were within the normal range. ④ 76 patients were performed CDFI and DSA examinations before the procedure, and the degrees of steno- sis in 74 patients diagnosed with both methods were consistent, including 2 were diagnosed as severe steno- sis with DSA, one was diagnosed as moderate stenosis and 1 was diagnosed as occlusion with CDF1. The coincidence rate was 97.4%. At t〉 6 months after procedure,20 patients were examined with DSA. Both CDFI and DSA showed that 19 had mild stenosis, and 1 had moderate stenosis. The coincidence rate was 100%. Conclusion Dynamically monitoring the stent lumen diameter of each segment and blood flow changes with CDFI after CAS may contribute to identify in-stent restenosis. Compared with DSA, its exami- nation results are reliable.