症状性颈动脉重度狭窄患者支架术后高灌注脑出血的风险评估

Risk assessment of hyperperfusion induced intracranial hemorrhage after stenting in patients with severe carotid stenosis

目的评估症状性颈动脉重度狭窄患者颈动脉支架置入术(CAS)后高灌注脑出血(HICH)发生的风险。方法回顾性分析第二军医大学附属长海医院神经外科2009年6月至2015年6月接受CAS治疗的210例症状性颈动脉重度狭窄(狭窄率70%~99%)患者的临床资料,其中7例(3.3%)术后发生了HICH。评估患者临床基线、影像学特点与HICH之间的关系。患者术前均接受脑CT灌注检查评估,定义脑血流量达峰时间(TTP)指数为患侧与对侧TTP的比值。计量资料的比较采用t检验,计数资料的比较采用Poisson检验。结果 HICH组和无HICH组TTP指数的差异有统计学意义(1.15±0.10比1.30±0.15,t=4.461,P<0.01)。ROC曲线分析结果提示,TTP指数>1.22可作为预测HICH的危险因子(敏感度为100%,特异度为75.9%)。结论颈内动脉重度狭窄患者,若术前TTP指数>1.22,提示在CAS后发生HICH的风险较高。

Objective To assess the risk of hyperperfusion induced intracranial hemorrhage（ HICH）after carotid artery stenting（ CAS） in patients with symptomatic severe carotid stenosis. Methods From June 2009 to June 2015,the clinical data of 210 patients with symptomatic severe carotid stenosis（ 70%-99%） treated with CAS at Department of Neurosurgery,Changhai Hospital,the Second Military Medical University,were analyzed retrospectively. Seven of them（ 3. 3 %） developed HICH after operation. The relationship between the clinical baseline and imaging characteristics and HICH were assessed. All patients received the evaluation of cerebral CT perfusion examination. The time to peak（ TTP） index of cerebral blood flow was defined as the TTP ratio of the affected and contralateral sides,t test was used to conduct the comparison of measurement data,and Poisson test was used to conduct the comparison of the enumeration data. Results There was significant difference in the TTP index between the HICH group and non-HICH group（ 1. 15 ± 0. 10 vs. 1. 30 ± 0. 15,t = 4. 461,P 0. 01）. The receiver operating characteristic（ ROC）curve analysis results suggested that the TTP index 1. 22 could be used as a risk factor for predicting HICH（ sensitivity 100 %,specificity 75. 9 %）. Conclusion Under the condition of prompting the preoperative TTP index 1. 22,the risk of HICH may be higher after CAS in patients with severe carotid stenosis.