DSA仿真内镜成像在颈内动脉颅外段狭窄诊治中的作用

Effect of DSA virtual endoscopy in the diagnosis and treatment of carotid artery stenosis

目的探讨3D DSA仿真内镜成像在颈动脉狭窄诊治中的价值。方法前瞻性收集南京医科大学附属淮安第一医院2017-01-2018-06行DSA旋转造影和3D DSA仿真内镜成像的颈动脉狭窄患者的临床及影像资料。DSA旋转造影图像通过球管和影像增强器的分2次同步旋转获得,应用InSpace软件对原始旋转图像进行三维重建,选择血管狭窄处,用Fly Through软件进行仿真内镜成像,观察血管腔内的结构情况。结果18个月内共123例颈动脉狭窄患者进行DSA旋转造影和仿真内镜成像,118例患者第一次造影即获得清晰的旋转造影和仿真内镜图像,5例因造影期间头部运动,成像不清晰,通过两次造影获得清晰图像。共发现163处血管狭窄,内膜形态光滑109处,不光滑54处;斑块偏心106处,基本不偏心57处。95例患者行颈动脉支架置入术,技术成功率100%,术后残余狭窄率均<30%,预后良好。95例支架置入的患者均进行三维DSA血管内镜随访,术后6个月时81例患者的支架被内膜完全覆盖、管腔光滑;术后12个月时95例患者的支架均被内膜覆盖完全。结论仿真三维DSA血管内镜成像是一种安全、有效的评估动脉管腔结构的方法,并可用于指导支架置入后个体化的抗血小板聚集治疗。

Objective To investigate the value of virtual 3D-DSA vascular endoscopy in the diagnosis and treatment of carotid artery stenosis.Methods Between January 2017 and June 2018,patients diagnosed as carotid artery stenosis in the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University were selected prospectively for this study.Demographic characteristics,medical history and imaging data were recorded.The 3D rotate pictures were obtained by the twice synchronized rotation of bulb and an image enhancer for 2400 rotation.The original 3D images were reconstructed using the InSpace software.The region of interest was selected.Fly Through software was used for 3D vascular endoscopic imaging and the endovascular structures were observed.Results During the 18 months period,123 carotid artery stenosis patients treated with DSA rotational angiography and virtual endoscopy were included.Among the 123 enrolled patients,118 patients obtained clear rotational and virtual endoscopy images at the first angiography,5 patients obtained clear images by two angiograms because of head movement during angiography.There were 163 vascular stenosis,the intima morphology in 109 of them were smooth and in 54 of them were rough.The plaques were decentered in 106 stenosis and were almost non-eccentric in 57.95 patients underwent carotid artery stenting,and the technical success rate was 100%.The postoperative residual stenosis rate was less than 30%and their prognosis was good.All patients underwent stenting were followed up with three-dimensional DSA endoscopy.The vascular intima was covered completely and smooth in 81 patients at 6 months after surgery and was covered completely in all patients at 12months after surgery.Conclusion The virtual vascular endoscopic imaging is a safe and effective method for evaluating the structures of carotid artery lumen.It also may be applied in guiding individualized antiplatelet aggregation drugs using after stenting.