DSA诊断缺血性脑血管病及评估介入治疗效果的价值

Value of DSA in diagnosing ischemic cerebrovascular disease and evaluating therapeutic effect after intervention

目的:探讨数字减影血管造影(DSA)诊断缺血性脑血管病及评估介入治疗效果的价值。方法:回顾性分析2014年1月~2015年6月我院诊治的134例缺血性脑血管病患者的临床资料,所有患者介入治疗前均接受了磁共振血管造影(MRA)、CT血管造影(CTA)、DSA检查,对比三种方法对缺血性脑血管病变的诊断价值;对比手术前后血管狭窄程度、美国国立卫生研究院卒中量表(NIHSS)评分的变化。结果:134例患者,共检查1340支血管,DSA检出病变血管341支(25.45%)、完全闭塞血管25支(1.87%)、狭窄率70%~99%血管153支(11.42%)、狭窄率50%~69%血管61支(4.55%)、狭窄率<50%血管102支(7.61%);与CTA、MRA比较,DSA的病变血管检出率(21.19%、19.40%比25.45%)、狭窄率50%~69%血管检出率(3.06%、2.54%比4.55%)、狭窄率<50%血管检出率(5.67%、4.93%比7.61%)均显著升高,P<0.05或<0.01。109例患者(120支血管)接受介入治疗,与术前比较,介入后颅外动脉狭窄率[(83.51±8.74)%比(22.87±7.90)%]、颅内动脉狭窄率[(81.63±9.02)%比(19.64±6.18)%]均显著降低(P均=0.001)。与术前比较,术后3个月患者的平均NIHSS评分[(14.68±3.18)分比(3.16±1.94)分]显著降低,P=0.001。结论:DSA对缺血性脑血管病患者血管病变检出率显著高于CTA、MRA,对术后效果评估也具有较高价值,值得推广。

Objective： To explore value of digital subtraction angiography （DSA） in diagnosing ischemic cerebrovascu- lar disease （ICD） and evaluating therapeutic effect after intervention. Methods： Clinical data of 134 ICD patients treated in our hospital from Jan 2014 to Jun 2015 were retrospectively analyzed. All patients received magnetic reso- nance angiography （MRA）, CT angiography （CTA） and DSA before intervention, and diagnostic value of three methods for ischemic cerebrovascular lesion were compared; stenotic degree of vessels and score of United States National Institutes of Health Stroke Score （NIHSS） were compared between before and after intervention. Results： A total of 1340 vessels were checked in 134 patients. DSA discovered 341 lesioned vessels （25.45%）, 25 completely occluded vessels （1.87%）, 153 vessels of 70% -99% stenosis （11.42%）, 61 vessels of 50%-69% stenosis （4.55%） and 102 vessels of 〈50% stenosis （7.61%） compared with CTA and MRA, there were significant rise in detection rates of lesioned vessels （21.19%, 19.40% vs. 25.45%）, 50%-69% stenosis vessels （3.06%, 2.54% vs. 4. 55%） and 〈50% stenosis vessels （5.67%, 4.93% vs. 7.61%） in DSA, P〈0.05 or 〈0.01. A total of 109 patients with 120 vessels received intervention, compared with before operation, there were significant reductions in stenotic rates of extracranial artery E （83.51 ± 8.74）% vs. （22.87 ± 7.90）%] and intracranial artery F （81.63 ± 9.02）% vs. （ 19.64 ± 6.18） % ] after intervention, P ： 0. 001 both. Compared with before intervention, there was significant re- duction in mean NIHSS score [ （14.68± 3.18） scores vs. （3.16± 1.94） scores] on three months after intervention, P = 0. 001. Conclusion： Detection rate of vascular lesion by DSA is significantly higher than those of CTA and MRA in ICD patients. Postoperative therapeutic effect assessment using DSA possesses high value, which is worth exten- ding.