颈内动脉中重度狭窄支架置入血管成形术后局部脑灌注的变化

Changes in Regional Cerebral Hemodynamics after Internal Carotid Artery Stenting in Patients with Moderate/Severe Internal Carotid Artery Stenosis

目的:观察颈内动脉中重度狭窄患者行支架置入血管成形术后局部脑灌注的变化。方法:中重度颈内动脉狭窄患者40例行支架置入血管成形术,术中术后均以血管造影明确颈动脉狭窄的情况,术前及术后10 d行CT脑灌注成像,观察局部脑血流速度(r CBF)、局部脑血容积(r CBV)、平均通过时间(MTT)的变化。结果:40例患者均成功完成颈内动脉狭窄腔内支架置入血管成形术,术后7 d内患者症状和神经功能缺损体征均明显改善,颈动脉狭窄程度明显减轻。术前患侧r CBV、r CBF明显低于对侧,MTT较对侧时间长(t=4.12、11.35、3.81,均P<0.05);术后患侧r CBV、r CBF均明显高于术前,MTT低于术前(t=3.32、3.79、9.30,均P<0.05)。术后无明显并发症。结论:采用支架置入血管成形术治疗颈内动脉中重度狭窄安全有效,可明显改善患者局部脑灌注。

Objective： To analysis the changes of regional cerebral hemodynamics after internal carotid artery stenting in patients with moderate/severe internal carotid artery stenosis. Methods： Forty patients with moderately/severe internal carotid artery stenosis were treated with carotid artery stenting angioplasty. Intraoperative and postoperative angiography were performed. CT perfusion imaging were performed preoperative and 10 days after operation. regional cerebral blood flow（r CBF）, regional cerebral blood volume（r CBV） and mean transit time（MTT） were analyzed. Results： Within 7 days after operation, neurological signs and symptoms of all patients were significantly improved and the degree of carotid stenosis was significantly reduced. The r CBV and r CBF of ipsilateral artery were lower and MTT was longer than those of contralateral artery（t=4.12, 11.35, 3.81, P〈0.05） preoperative. Compared with those of preoperation, the r CBV and r CBF of ipsilateral artery were significantly increased and MTT was significantly decreased after operation（t=3.32, 3.79, 9.30, P〈0.05）. There were no significant complications. Conclusion： Internal carotid artery stenting is effective and safe to treat moderately/severe internal carotid artery stenosis and the cerebral perfusion of patients were significantly improved.