TCD评价支架治疗颈动脉狭窄的疗效及与过度灌注的相关性

TCD evaluation of the clinical efficacy of the treatment of carotid artery stenosis by stents and the reationship to hyperperfusion

目的探讨经颅多普勒(TCD)评价颈动脉狭窄行支架植入治疗的临床疗效及与过度灌注的相关性。方法选取我科收治颈动脉狭窄行支架植入术患者68例为研究对象,所有患者术前均行TCD及脑血管造影(DSA)检查,根据TCD检查结果,分为观察组(无交通动脉开放)和对照组(交通动脉开放),观察术前和术后1 m、2 m狭窄处及狭窄远端收缩期峰值流速(PV)、平均血流速度(MV),评价临床疗效;观察组和对照组术后12 h、24 h、48 h行病变侧大脑中动脉(MCA)血流速度检测。结果术前血管狭窄处PV、MV明显升高,远端血管PV、MV降低,术后1个月、2个月支架内血流速度降低,狭窄远端血流速度升高,术前、术后比较差异有统计学意义(P<0.05);术后12 h、24 h及48 h患者病变侧MCA PV、MV监测,观察组和对照组比较差异有统计学意义(P<0.05)。结论TCD观察患者血流动力学变化,可有效评价支架治疗颈动脉狭窄短期疗效,并有利于长期随访;观察组术后脑血流速度增快明显,对血压变化敏感,更容易发生过度灌注,TCD监测对支架术后严格控制血压,预防过度灌注的发生有重要意义。

Objective Explore the clinical efficacy of stent implantation to cure the carotid artery stenosis(CAS)by transcranial Doppler and the correlation of Hyperperfusion.Methods 68 patients in our department with carotid stenosis treated by stent implantation are chosen as the objects of study.Preoperative TCD and cerebral angiography(DSA)examinations are done to all the patients.According to the results of TCD examination,all the patients are divided into two groups,observation group(without communicating artery open)and control group(with communicating artery open).Observations of the peak velocity(PV)and average blood flow velocity(MV)at the stenosis level of 1-month,2-month and distal end during the systole period preoperatively and postoperatively are done.Evaluation of the clinical efficacy,blood flow velocity(MV)of the middle cerebral artery(MCA)on the lesion side is detected to the observation group and the control group 12h,24h,and 48h postoperatively.Results PV and MV were significantly increased at the vascular stenosis preoperatively,but decreased at the distal end.The blood flow velocity in the stent decreased at 1-month and 2-month postoperatively,and increased at the distal vascular stenosis.The comparison preoperatively and postoperatively means statistically(P<0.05).The comparison between the observation group and control group in MCA PV and MV monitoring on the lesion side of the patients 12h,24h,and 48h postoperatively means statistically(P<0.05).Conclusion The observation of hemodynamic changes in patients by TCD can effectively evaluate the short-term efficacy of the treatment of CAS by stents therapy as well as benefits the long-term follow-up.In the observation group,the postoperative cerebral blood flow velocity increased significantly,and sensitive to changes in blood pressure,which was more prone to overperfusion.TCD monitoring strictly controls blood pressure after stenting operation,which is of great significance to prevent the occurrence of overperfusion.