颈动脉支架术对颈动脉狭窄患者脑血管反应性的影响

The effect of carotid artery stenting on cerebral vascular reactivity in patients with carotid stenosis

目的分析颈动脉支架术(CAS)对颈动脉重度狭窄患者脑血管反应性(CVR)的影响。方法于CAS手术前1周内及术后3个月,通过单光子发射计算机断层扫描联合CO2吸入法对30例单侧颈内动脉起始部重度狭窄患者的狭窄同侧大脑中动脉(MCA)供血区的4个感兴趣区(ROI)进行相对脑血流量(r CBF)检测及相对CVR(r CVR)评估。结果 84个ROI术前r CVR下降,63个ROI术后r CVR得以改善(75.00%)。根据术前r CBF和r CVR分为1型22个(18.33%),2型49个(40.83%),3型35个(29.17%),4型14个(11.67%)。2型ROI术后45个改善,改善率为91.84%;3型ROI术后18个改善,改善率为51.43%;1型和4型ROI术后未见明显改善。2型ROI改善率显著高于3型ROI(P<0.001)。结论 CAS能够部分改善颈动脉狭窄患者的r CVR,其改善程度可能与术前r CVR相关。2型ROI较3型ROI术后更易于改善。

Objective To analyze the effect of carotid artery stenting（ CAS） on cerebral vascular reactivity（ CVR） in patients with severe carotid stenosis. Methods The relative cerebral blood flow（ r CBF） detection and relative cerebral vascular response（ r CVR） in four region of interests（ ROIs） in the bilateral middle cerebral artery region were evaluated by single photon emission computed tomography combined with carbon dioxide（ CO2）inhalation within 1 week before surgery and postoperative 3 months in 30 patients with unilateral severe internal carotid artery stenosis. Results Preoperative r CVR was decreased in 84 ROIs,and 63 of which were improved postoperatively（ 75. 00%）. According to the preoperative CBF and CVR,they were divided into type 1（ 22,18. 33%）,type 2（ 49,40. 83%）,type 3（ 35,29. 17%）,and type 4（ 14,11. 67%）. Fouty-five ROIs of type 2 were improved postoperatively, the improvement rate was 91. 84%. Eighting ROIs of type 3 were improved postoperatively,and the improvement rate was 51. 43%. No significant improvement was found in type 1 and type 4 ROI. The improvement rate in type 2 was significantly higher than that in type 3（ P 〈 0. 001）. Conclusions CAS can partly improve the r CVR in patients with carotid stenosis. The degree of improvement may be associated with preoperative r CVR,and type 2 ROI is easier to improve than that of type 3 ROI.