超声评价颈动脉内膜剥脱术和支架置入术后颈动脉再狭窄的价值

Value of Color Doppler Ultrasound in the Evaluation of Carotid Artery Restenosis after Carotid Artery Stenting or Carotid Endarterectomy

目的:探讨彩色多普勒超声评价颈动脉支架置入术(carotid artery stenting,CAS)和内膜剥脱术(carotid endarterectomy,CEA)后颈动脉再狭窄的价值。方法:经数字减影血管造影确诊53例患者共62支血管颈动脉狭窄,回顾分析患者CAS或CEA术前和术后的彩色多普勒超声结果,超声指标包括颈内动脉(internal carotid artery,ICA)狭窄处血管内径、ICA和颈总动脉(common carotid artery,CCA)狭窄处收缩期峰值流速(peak systolic velocity,PSV)以及ICA舒张末期流速(end diastolic velocity,EDV)。结果:经治疗后,52支血管无明显再狭窄(狭窄率<50%),病变血管内径较术前明显增宽(P<0.01),PSVICA明显降低(P<0.01);10支血管出现≥50%的再狭窄,术后血管内径和PSVICA较术前无明显变化(P>0.05);出现≥50%再狭窄血管的PSVICA、EDVICA及PSVICA/PSVCCA较无明显狭窄血管明显增高(P<0.01)。以PSVICA/PSVCCA≥2作为诊断标准,其预测术后再狭窄≥50%的敏感性和特异性分别为80.0%和98.1%。结论:彩色多普勒超声能够有效地评价CAS和CEA术后颈动脉再狭窄。

Objective：To investigate the value of color Doppler ultrasound in the evaluation of carotid artery restenosis after ca-rotid artery stenting （CAS） and carotid endarterectomy （CEA） .Methods ：A total of 53 patients with 62 carotid artery stenosis diagnosed by digital subtraction angiography （DSA） were enrolled .All of them underwent CAS and CEA .The postoperative and preoperative ultrasound datum including the minimum luminal diameter ,the peak systolic velocity （PSV ）of the internal ca-rotid artery （ICA） and common carotid artery （CCA） ,end diastolic velocity （EDV） of ICA were retrospectively analyzed . Results：A total of 52 arteries were normal or had 〈50% restenosis ,while 10 arteries had ≥50% restenosis after the treat-ment .Compared with those before treatment ,the minimum luminal diameter was significantly wider ,and PSVICA decreased significantly in patients with 〈50% restenosis（P〈0 .01） ,whereas the minimum luminal diameter and PSVICA were not sig-nificantly changed in patients with≥50% restenosis（P〉0 .05） .PSVICA ,EDVICA and PSVICA/PSVCCA in patients with≥50% restenosis significantly increased compared with that in patients with 〈50% restenosis（P〈0 .01） .PSVICA/PSVCCA≥2 was set as the cut-off point ,the sensitivity and specificity for detecting ≥50% restenosis were 80 .0% and 98 .1% respective-ly .Conclusions ：Color Doppler ultrasound can effectively evaluate carotid artery restenosis after CAS or CEA .