颈动脉支架置入术对缺血性眼病患者眼部血流的影响

Effect of carotid artery stenting on ophthalmic artery blood flow in patients with ischemic ophthalmopathy

目的通过彩色多普勒血流显像(CDFI)评估颈动脉支架置入术(CAS)对缺血性眼病(IOP)患者的眼部血流动力学影响。方法选取28例符合CAS入选标准的IOP患者,于术前、术后3d及6个月行颈动脉CDFI、眼球CDFI和数字减影全脑血管造影检查,检测记录眼动脉(OA)和视网膜中央动脉(CRA)的收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)和阻力指数(RI)3项血流动力学指标,同时结合频谱形态改变来评价IOP患者眼部血流改善程度。并记录患者术前、术后3d及6个月log Mar最佳矫正视力情况。结果 28例患者术后3d和术后6个月OA、CRA的PSV、EDV值均较术前增加,差异均有统计学意义(均P<0.05);而术后3d和术后6个月同类指标比较,差异均无统计学意义(均P>0.05)。术后3d频谱形态恢复正常,其中10例OA反向血流恢复正向血流。Log Mar最佳矫正视力术前为1.34±0.79,术后3d为1.27±0.82,术后6个月为1.06±0.83,最佳矫正视力术后6个月较术前和术后3d均有提高,差异均有统计学意义(均P<0.05)。结论颈动脉狭窄性IOP患者行CAS后,眼部血供明显改善,视功能有一定程度恢复。

Objective To investigate the effects of carotid artery stenting（CAS） on ophthalmic artery blood flow in patients with ischemic ophthalmopathy（IOP）. Methods Twenty eight patients with IOP scheduled for CAS were enrolled in the study.Color Doppler flow Imaging（CDFI） and digital substraction angiography were performed to examine the ophthalmic and carotid artery blood flow before and 3 days, 6 months after stenting. The peak systolic velocity（PSV）, end-diastolic velocity（EDV）, and resistance index（RI） in the ophthalmic artery（OA） and central retinal artery（CRA） were documented, and the best corrected visual acuity was measured. Results The PSV and EDV of OA and CRA in all 28 patients were significant increased 3 days and 6months after stenting（all P〈0.05）, there was no significant difference in these parameters between 3 days and 6 months after stenting（all P〉0.05）. A change in the flow direction from etrograde to antegrade was found in 10 patients after stenting. The logMar best corrected visual acuity before and 3 days, 6 months after stenting was 1.34±0.79, 1.27±0.82 and 1.06±0.83, respectively（P〈0.05）. Conclusion CAS can improve ophthalmic artery perfusion and improve the visual function of patients with IOP.