TCD联合SPECT评价颈动脉支架成形术对脑血管反应性的影响

Infuence of cerebrovascular reactivity after carotid artery stenting with TCD combined with SPECT

目的探讨颈动脉支架成形术(CAS)对脑血管反应性(CVR)的影响。方法 CAS术的患者27例为手术组,重度颈动脉狭窄患者21例为对照组,对照组给予阿司匹林和氯吡格雷双抗治疗3个月。治疗前及治疗后3个月,用TCD结合呼吸试验测量静息、过度换气及屏气后双侧大脑中动脉(MCA)的脑血流速度,然后计算CVR的变化;SPECT检测治疗前及治疗后3个月患者脑血流灌注显像的变化。结果两组患者治疗后患侧CVR均明显高于治疗前(P<0.05),且手术组改善优于对照组(P<0.05);手术组治疗后健侧CVR高于治疗前(P<0.05),对照组治疗前后健侧CVR无统计学差异(P>0.05);两组患者治疗后患侧脑血流灌注均明显高于治疗前(P<0.05),且手术组改善优于对照组(P<0.05);两组治疗前后健侧脑血流灌注无统计学差异(P>0.05)。结论与常规药物组相比,CAS能更好提高患者3个月后脑血管反应性,增加脑血流灌注。

Objective To investigate the effect of carotid artery stenting(CAS)on cerebrovascular reactivity(CVR).Methods 27 patients undergoing CAS were selected as operation group,21 patients with severe carotid artery stenosis as control group,and the control group was treated with aspirin and clopidogrel double antibody for 3 months.Before treatment and 3 months after treatment,the cerebral blood flow velocity of middle cerebral artery(MCA)at resting,overventilation and breath holding were measured by TCD combined with breath test,and then the CVR was calculated.The changes of cerebral blood flow imaging before and 3 months after treatment were detected by SPECT.Results The CVR on the affected side in both groups after treatment were significantly higher than those before treatment(P<0.05),and the improvement of the operation group was better than that of the control group(P<0.05).The CVR on the uninjured side after CAS of the operation group was also significantly improved than those before treatment(P<0.05),but no difference in the control group(P>0.05).The cerebral blood flow perfusion on the affected side in the two groups after treatment was significantly higher than that before treatment(P<0.05),and the improvement of the operation group was better than that of the control group(P<0.05).There was no statistically different cerebral blood flow perfusion on the uninjured side between the two groups before and after treatment(P>0.05).Conclusion Compared with the conventional drug group,CAS can improve the cerebrovascular reactivity after 3 months and increase the cerebral blood flow perfusion.