颈动脉支架成形术对单侧症状性颈内动脉重度狭窄患者脑血流和脑血管反应性的影响

Effect of carotid artery stenting on CBF and CVR in patients with unilateral internal carotid artery symptomatic severe stenosis

目的探讨颈动脉支架成形术(CAS)对局部脑血流量(rCBF)和局部脑血管反应性(rCVR)的影响。方法选择2014年8月~2015年12月空军总医院神经内科进行CAS治疗的单侧症状性颈内动脉重度狭窄患者17例,术前1周及术后3个月通过单光子发射计算机断层扫描联合CO2负荷试验评估rCBF和rCVR,选择狭窄同侧大脑中动脉供血区感兴趣区分析。结果 17例患者共有68个感兴趣区,术前所有感兴趣区rCVR均受损,而仅16个(23.5%)感兴趣区rCBF受损。术前rCBF和rCVR均受损的感兴趣区术后平均rCBF较术前显著升高[(86.7±10.0)%和(79.1±7.5)%,P=0.001],术前rCBF正常且rCVR受损的感兴趣区术后平均rCVR较术前显著升高[(4.9±8.6)%vs(1.1±6.7)%,P=0.014]。术前rCBF和rCVR均受损的感兴趣区术后rCBF改善率显著高于术前rCBF正常且rCVR受损的感兴趣区(81.3%vs 50.0%,P=0.027);术前rCBF正常且rCVR受损的感兴趣区术后rCVR改善率显著高于术前rCBF和rCVR均受损的感兴趣区(59.6%vs 31.3%,P=0.047)。结论对于颈动脉狭窄患者,CAS能够改善术前存在脑血流动力障碍感兴趣区的rCBF和rCVR,其改善的模式与术前脑血流动力障碍严重程度有关。

Objective To study the effect of carotid artery stenting（CAS）on rCBF and rCVR.Methods Seventeen patients with unilateral internal carotid artery symptomatic severe stenosis who underwent CAS in our hospital were included in this study.Their rCBF volume and rCVR were measured by single photon emission CT scanning combined with CO2 loading test 1 week before and 3 months after CAS.Their data were analyzed according to the ROI in ipsilateral middle cerebral artery blood supply territory.Results Sixty-eight ROIs were detected in the 17 patients with impaired rCBF in 16 ROIs（23.5%）before CAS.The mean improved rate of rCBF was significantly higher in impaired rCBF and rCVR ROI before CAS than that of rCBF in normal and impaired rCVR ROI after CAS（P=0.001）.The mean improved rate of rCVR was significantly higher in normal rCBF and impaired rCVR ROI after CAS than before CAS（P=0.014）.The improved rate of rCBF was significantly higher in impaired rCBF and rCVR ROI after CAS than that of normal and impaired rCVR ROI before CAS（81.3%vs 50.0%,P=0.027）.The improved rate of rCVR was significantly higher in normal rCBF ROI and impaired rCVR ROI before CAS than in impaired rCBF and rCVR ROI after CAS（59.6%vs 31.3%,P=0.047）.Conclusion CAS can improve the ROI rCBF and rCVR in patients with unilateral ICA symptomatic severe stenosis.Its modified model is closely related with rCBF before CAS.