颈动脉支架植入术对颈内动脉狭窄患者脑血流量及脑血管反应性的影响

Effect of carotid artery stenting on cerebral blood flow and cerebrovascular reactivity in patients with internal carotid artery stenosis

目的探讨颈动脉支架植入术（CAS）对颈内动脉起始部重度狭窄患者脑血流量及脑血管反应性的影响。方法对空军总医院神经内科自2014年8月至2015年12月收治的20例经颈动脉彩超或磁共振血管成像（MRA）筛查证实为单侧颈内动脉起始部重度狭窄患者实施CAS手术，并在术前1周及术后3个月通过单光子发射计算机断层扫描（SPECT）检查联合CO2吸入法检测评估相对脑血流量（rCBF）及相对脑血管反应性（rCVR），进一步选择双侧大脑中动脉供血区各4个对称感兴趣区，分别比较患侧及健侧感兴趣区rCBF、rCVR在CAS手术前后的变化。结果20例患者双侧分别各获得80个对称感兴趣区。术前患侧rCBF平均为0．883±0．075，健侧平均为O．929±0．033；术前患侧rCVR平均为0．010±0．055，健侧平均为0．124±0．053；术后患侧rCBF平均为0．927±0．040，健侧平均为0．938±0．038；术后患侧rCVR平均为0．092±0．058，健侧平均为0．127±0．054。患侧术后rCBF、rCVR与术前比较明显改善，差异均有统计学意义（P〈0．05）；健侧术后rCBF、rCVR与术前比较有所改善，但差异无统计学意义（P〉0．05）。结论CAS手术不仅可以改善患者狭窄侧大脑中动脉供血区的rCBF及rCVR，而且对健侧也有部分改善作用。

Objective To analyze the effect of carotid artery stenting （CAS） on cerebral blood flow and cerebrovascular reactivity in patients with severe carotid stenosis. Methods Twenty patients with unilateral severe internal carotid artery stenosis, conformed by carotid color ultrasonography or MR angiography in our hospital from August 2014 to December 2015, were chosen in our study. CAS was performed; relative cerebral blood flow （rCBF） detection and relative cerebrovascular reactivity （rCVR） assessment were performed by single photon emission computed tomography （SPECT） combined with carbon dioxide （COs） inhalation within one week before surgery and 3 months after surgery. Four regions of interest （ROIs） in the bilateral middle cerebral artery （MCA） territory of internal carotid stenosis were selected for data analysis. The changes ofrCBF and rCVR before and after CAS between the ipsilateral and contralateral ROIs of these patients were compared. Results In these 20 patients, 80 ROIs from each patient were obtained. Preoperative ipsilateral rCBF averaged 0.883±0.075, and contralateral rCBF averaged 0.929±0.033; preoperative ipsilateral rCVR averaged 0.010±0.055, and contralateral rCBF averaged 0.124±0.053; postoperative ipsilateral rCBF and rCVR averaged 0.927±0.040 and 0.092±0.058, and contralateral rCBF averaged 0.938±0.038 and 0.127±0.054. Postoperative ipsilateral rCBF and rCVR were significantly improved as compared with preoperative ones （P〈0.05）. Postoperative contralateral rCBF and rCVR were improved as compared with preoperative ones, without significant differences （P〉0.05）. Conclusions CAS can not only improve rCBF and rCVR of the MCA in the carotid artery stenosis, but also improve the contmlateral side.