症状性大脑中动脉粥样硬化性狭窄支架植入术后血流动力学研究

Hemodynamic study on symptomatic middle cerebral artery atherosclerotic stenosis after stent implantation

目的 探讨症状性大脑中动脉粥样硬化性狭窄患者接受颅内支架植入术前后脑血流动力学变化。方法 回顾成功实施颅内支架植入术的39例症状性大脑中动脉粥样硬化性狭窄患者基线资料,对采用经颅多普勒超声检测术前、术后1周、术后3个月大脑中动脉狭窄段收缩期峰值流速（PSV）和脉动指数（PI）进行分析,比较手术前后病变血管血流动力学变化。结果 39例患者中1例术后狭窄改善不明显,38例动脉平均管径狭窄率由治疗前（80.3±8.5）%改善为术后即刻（16.3±9.2）%（P=0.011）。术后1周、术后3个月大脑中动脉狭窄段PSV与术前比较有明显降低（P=0.023）,PI也较术前明显降低（P=0.028）。术后3个月时2例患者平均PSV回复升高31%-39%;术后3个月与术后1周比较,平均PSV略有升高（P=0.129）,PI稍有增高（P=0.115）,但差异无统计学意义。结论 症状性大脑中动脉粥样硬化性狭窄患者接受颅内支架植入术后短期内脑血流得到有效增加,长期血流改善程度有待观察。

Objective To investigate the cerebral hemodynamic changes in patients with symptomatic middle cerebral artery atherosclerotic stenosis after intracranial stent implantation. Methods A total of 39 patients with symptomatic middle cerebral artery atherosclerotic stenosis, who had successfully treated with intracranial carotid stenting, were included in this study. The baseline data were retrospectively analyzed. Using transcranial Doppler sonography （TCD） the peak systolic velocity （PSV） and the pulse index （PI） of middle cerebral artery stenotic segment were measured before treatment and also at one week, 3 months after treatment, the changes of blood flow dynamics in the diseased arteries before and after treatment were compared. Results Of the 39 patients, no obvious improvement of stenosis after treatment was seen in one, and in 38 the average diameter stenosis rate was improved from preoperative 80.3%±8.5% to postoperative 16.3%±9.2%, the difference was statistically significant （P=0.011）. The values of middle cerebral artery stenotic segment PSV measured at one week and 3 months after treatment were evidently lower than preoperative ones （P=0.023）, and PI values of middle cerebral artery stenotic segment measured at one week and 3 months after treatment were also significantly decreased when compared to preoperative ones （P= 0.028）. Three months after treatment, the mean PSV values of 2 patients increased by 31%-39% ; the 3 - month mean PSV and PI values were slightly increased when compared with the values measured at one week after treatment but the differences were not statistically significant （P=0.129 and P=0.115 respectively）. Conclusion For patients with symptomatic middle cerebral artery atherosclerotic stenosis, intracranial carotid stent implantation can effectively improve cerebral blood flow in a short time, but its long-term effectiveness needs to be clarified.