经颅彩色多普勒超声在基底动脉支架中的临床分析

Clinical analysis of transcranial color-coded Dopplex sonography in basilar artery stent

目的应用经颅彩色多普勒超声(transcranial color-coded Dopplex sonography,TCCS)评估基底动脉狭窄支架植入术前后血流动力学变化与术后再狭窄发生率。方法回顾分析经TCCS检查及数字减影血管造影证实的96例神经内、外科重度症状性基底动脉狭窄行支架植入术患者。检查记录术前、术后1个月内及术后3、6、12个月基底动脉狭窄段、椎动脉颅内段、大脑后动脉(取较高侧测值)的收缩期峰值流速(peak systolic velocity,PSV)、血管搏动指数(pulsatility index,PI)、平均流速(mean flow velocity,MFV)和舒张期末流速(end diastolic velocity,EDV)。比较术前、术后血流动力学参数变化,分析再狭窄发生率。结果支架植入术后1个月内基底动脉PSV、EDV、MFV均较术前明显下降,PI出现明显上升趋势(P<0.05),椎动脉颅内段PSV、MFV、EDV与术前相比明显升高(P<0.05)。相比术前,后交通动脉未开放的54例患者大脑后动脉PSV、EDV、MFV及PI均明显升高(P<0.05)。在随访96例患者的过程中,出现支架内再狭窄28例,累积再狭窄发生率在3、6、12个月内分别为14.6%(14/96)、19.8%(19/96)、29.2%(28/96)。结论应用TCCS对后循环各段动脉PSV、EDV、MFV的变化进行检测,可以对基底动脉支架植入的疗效进行客观评估,是基底动脉支架植入术后再狭窄筛查的重要手段。

Objective To evaluate the hemodynamic changes and the incidence of restenosis after stenting in patients with basilar artery stenosis by transcranial color-coded Dopplex sonography(TCCS). Methods Retrospective analysis of TCCS and digital subtraction angiography confirmed 96 cases of severe symptomatic basilar artery stenosis in the department of neurology and department of neurosurgery.Systolic peak flow velocity(PSV),vascular pulsatility index(PI),mean flow velocity(MFV)and end diastolic flow velocity(EDV)of the basilar artery stenosis segment,the vertebral artery,the intracranial segment,and the posterior cerebral artery(measured at higher side)within 1 months and after 3,6,12 month were checked and recorded before and after operation.The hemodynamic parameters were compared before and after operation,and the incidence of restenosis was analyzed.Results The PSV,EDV and MFV of the basilar artery were significantly lower in the 1 months after stent implantation,and PI showed a marked upward trend(P<0.05).The intracranial vertebral artery PSV,MFV,EDV were significantly increased compared with the preoperative parameters(P<0.05).Compared with the preoperative and posterior communicating arteries,the PSV,EDV,MFV and PI in the posterior cerebral arteries were significantly increased in all the 54 patients(P<0.05).During the followup of 96 patients,there were 28 patients with stent restenosis.The cumulative restenosis rate were 14.6%(14/96),19.8%(19/96)and 29.2%(28/96)at 3,6 and 12 months respectively.Conclusion TCCS was used to detect the changes of PSV,EDV and MFV in the posterior circulation,it can objectively evaluate the therapeutic effect of basilar artery stent implantation,and is an important screening method for restenosis after basilar artery stenting.