改良TCD颈总动脉压迫试验诊断侧支循环通路开放与存在的价值

Modified TCD Common Carotid Artery Compress to evaluate the significance of collateral circulation opening and existence

目的探讨改良TCD颈总动脉压迫试验诊断前交通动脉、后交通动脉开放或存在的准确性和价值。方法回顾性分析数字减影血管造影诊断的192例颈内动脉狭窄≥70%或闭塞患者(病变组)和136例颈内动脉无重度狭窄或闭塞患者(正常组)资料,患者均接受改良颈总动脉压迫试验,比较两种检查方法诊断前交通动脉、后交通动脉开放与存在的准确度。结果TCD和数字减影血管造影在单纯前交通动脉开放的检测中,一致性检验Kappa值=0.941(P<0.001);在单纯后交通动脉开放的检测中,一致性检验Kappa值=0.903(P<0.001);在前交通动脉/后交通动脉均开放的检测中,一致性检验Kappa值=0.924(P<0.001);在前交通动脉/后交通动脉均未开放的检测中,一致性检验Kappa值=0.943(P<0.001);在单纯前交通动脉存在的检测中,一致性检验Kappa值=0.936(P<0.001);在单纯后交通动脉存在的检测中,一致性检验Kappa值=0.932(P<0.001);在前交通动脉/后交通动脉均存在的检测中,一致性检验Kappa值=0.917(P<0.001);在前交通动脉/后交通动脉均不存在的检测中,一致性检验Kappa值=0.910(P<0.001);两种检查方法在检测前交通动脉、后交通动脉开放与存在上有一致性。结论改良颈总动脉压迫试验可以提高诊断一级侧支循环通路是否开放的准确性;解决前交通动脉、后交通动脉未开放时是否存在的诊断问题,有助于颈动脉内膜切除术术前精准评估,保障手术安全,与数字减影血管造影符合度高,可以进行推广。

Objective To investigate the accuracy and significance of the modified TCD Common Carotid Artery Compress to evaluate the anterior communicating artery and posterior communicating artery.Methods Da⁃ta of 192 patients with internal carotid artery stenosis≥70%or occlusion(lesion group)diagnosed by digital subtraction angiography and 136 patients without severe stenosis or occlusion(normal group)with internal carotid artery were retrospectively analyzed,All patients underwent a modified Common Carotid Artery Compress to compare the accuracy of the diagnosis of the anterior communicating artery and posterior communicating artery is opening and existed.Results Transcranial Doppler and digital subtraction angiography in the pure the anterior communicating artery opening test,the value of Kappa is 0.941(P<0.001),In the simple posterior communicating artery opening test,the value of Kappa is 0.903(P<0.001).In the tests where both the anterior communicating artery/posterior communicating artery are open,the value of Kappa is 0.924(P<0.001),In tests where neither the anterior communicating artery/posterior communicating artery is open,the value of Kappa is 0.943(P<0.001),In the detection of the presence of posterior communicating artery alone,the value of Kappa is 0.932(P<0.001),and in the detection of both the anterior communicating artery/posterior communicating artery,the value of Kappa is 0.917(P<0.001),In the absence of the anterior communicating artery/posterior communicating artery,the value of Kappa is 0.910(P<0.001).The two inspection methods are consistent in detecting the openness and existence of the anterior communicating artery and posterior communicating artery.Conclusion Modified TCD Common Carotid Artery Compress can improve the accuracy of diagnosing whether the primary collateral circulation path⁃way is open;To solve the problem of whether the anterior and posterior communication arteries are not open but exist.It is helpful for accurate preoperative evaluation of carotid endarterectomy.It can ensure the safety of opera⁃tion.It is high compliance with digital subtraction angiography and can be promoted.