颈动脉内膜切除术治疗颈动脉次全或完全闭塞患者的术前超声评估

Preoperative ultrasound assessment of carotid endarterectomy for the treatment of patients with subtotal or complete occlusion of carotid artery

目的：应用彩色多普勒血流显像（ CDFI）及经颅多普勒超声（ TCD）评估颈动脉次全或完全闭塞患者接受颈动脉内膜切除术（ CEA）前血管结构、血流动力学变化与血管再通的相关性。方法回顾性纳入2005年1月-2014年1月在首都医科大学宣武医院经DSA确诊为颈动脉次全闭塞（狭窄率95%-99%）或完全闭塞,并接受 CEA 治疗的患者共107例,平均年龄（61±9）岁。根据DSA结果,将107例患者分为颈动脉次全性闭塞组63例和颈动脉完全性闭塞组44例。记录两组患者术前病变各段血管内径、病变的位置（颈内动脉或颈总动脉）、管腔内回声特征及颈内-外动脉侧支循环是否开放、与血管再通的相关性。结果颈动脉完全性闭塞组患者远心段血管内径较次全性闭塞组明显增宽[（4．1±1．1）、（3．2±0．8） mm],两组差异有统计学意义（P〈0．01）；闭塞位置与手术再通率差异无统计学意义（P=0．460）；血管腔内均质回声（低回声与等回声）充填者的再通率[94．1%（16/17）和86．7%（13/15）]均明显高于不均质回声患者的再通率[0（0/12）,P〈0．01]。在颈内动脉完全闭塞患者中,颈内-外侧支动脉开放时CEA的再通率增加[70.0%（14/20）比0%（0/3）]。总体比较,颈动脉次全性闭塞组较完全性闭塞组的再通比率明显升高[90.5%（57/63）比65.9%（29/44）,P〈0．01]。结论颈动脉管径正常或增宽、闭塞管腔内均质回声及颈内-外动脉侧支开放与血管再通密切相关。术前超声检查对颈动脉闭塞性病变CEA实施后再通性的评估具有重要价值。

Objective To evaluate the correlations of vascular structures,hemodynamic changes and recanalization before receiving carotid endarterectomy （ CEA） in patients with subtotal or complete occlusion of carotid artery using color Doppler flow imaging （CDFI） and transcranial Doppler （TCD） ultrasonography. Methods A total of 107 patients were diagnosed as subtotal （ stenosis rate 95% to 99%） or complete occlusion of carotid artery with DSA and treated with CEA at Beijing Xuanwu Hospital, Capital Medical University from January 2005 to January 2014 were enrolled retrospectively. The mean age of patients was 61 ± 9 years. According to the findings of DSA,they were divided into either a carotid artery subtotal occlusion group （n=63） or a complete occlusion group （n=44）. The vascular diameter,the locations of the lesions （ internal carotid artery or common carotid artery） ,the lumen echo characteristics,and whether internal-external artery collateral circulation patent or not at different stages in patients of both groups were documented. Results The lumen diameter of distal segment was significant wider in patients of the＆amp;nbsp;complete occlusion group compared with the subtotal occlusion group （4. 1 ± 1. 1 mm vs. 3. 2 ± 0. 8 mm）. There was significant difference between the 2 groups （P 〈0. 01）. There was no significant difference between the location of occlusion and the recanalization rate （P=0. 460）. The recanalization rate of the lumen homogeneous echo （ hypoecho and echodense） filling patients （94. 1% vs. 86. 7%） was significantly higher than that of the patients of heterogeneity echo. In patients with complete occlusion of internal carotid artery,the recanalization of CEA would increase when the internal-external collateral arteries were patent. For general comparison,the recanalization rate of the subtotal occlusion group was significantly higher than that of the complete occlusion group （P〈0. 01）. Conclusion The carotid artery diameter normal or broadening ,the homogeneous echo in the occlusive lumen and the internal-external collateral arteries patency are closely associated with the recanalization rate. The preoperative ultrasonography has great value for the assessment of recanalization of carotid artery occlusive disease after CEA.