单侧症状性颈动脉狭窄CEA术后早期脑血流动力学变化:CT灌注研究

Early changes in cerebral hemodynamics during carotid endarterectomy in patients with unilateral symptomatic carotid artery stenosis:A computed tomography perfusion study

目的应用计算机断层扫描灌注成像(CTP)来研究单侧症状性颈动脉狭窄患者行颈动脉内膜切除术(CEA)术前及术后早期脑血流动力学变化情况,并探讨其与围手术期并发症的关系。方法回顾性分析北京中医药大学东方医院和中国人民解放军总医院2018年3月—2020年7月收治的27例单侧症状性颈动脉狭窄患者的临床资料,所有患者均行CEA,在术前72 h内、术后24 h内分别行CTP检查,获得感兴趣区CTP伪彩图及定量数据,比较CEA前后2次CTP参数,记录围手术期并发症。用△CBF来表示患侧MCA供血区脑血流量(CBF)变化情况。结果CEA术前患侧与健侧比较,CBF患侧较健侧低,到达峰值时间(TTP)患侧较健侧长;CEA术后患侧与健侧比较,CBF及脑血容量(CBV)患侧较健侧明显升高;患侧CEA前后CBF及CBV增加,TTP缩短。△CBF<0有1例,0△CBF 50%有21例,△CBF>50%有5例。3例患者出现高灌注综合征,其△CBF均大于50%;1例△CBF<0患者,TTP明显延长,术后CT证实出现脑梗塞。这组患者出院时均恢复良好,无死亡病例。结论CTP能敏感反映CEA术后早期脑血流动力学变化,评估脑自动调节功能,预测高灌注综合征、脑梗塞等并发症,是CEA一种重要的辅助监测手段。

Objective To apply computed tomography perfusion(CTP)to study the changes in cerebral hemodynamics during carotid endarterectomy(CEA)in patients with unilateral symptomatic carotid artery stenosis.To explore the relationship between the changes and perioperative complications.Methods The clinical data of 21 patients with unilateral symptomatic carotid artery stenosis admitted in Dongfang Hospital,Beijing University of Chinese Medicine and Chinese PLA General Hospital from March 2018 to July 2020 were analyzed retrospectively.All patients underwent CEA,and CTP was performed before and after surgery.CTP pseudo-color map and quantitative data of the region of interest were obtained.The CTP parameters before and after CEA were compared.Perioperative complications were recorded.△CBF was used to represent the changes of cerebral blood flow(CBF)in the affected MCA blood supply area.Results Compared with the healthy side before CEA,CBF in the affected side was lower than that in the healthy side,and the time to peak(TTP)in the affected side was longer than that in the healthy side.CBF and cerebral blood volume(CBV)in the affected side were significantly higher than those in the healthy side after CEA.CBF and CBV increased and TTP shortened before and after CEA.△CBF<0occurred in one case,0≤△CBF≤50%occurred in 21 cases,and△CBF was>50%in five cases.△CBF was>50%in three patients with hyperperfusion syndrome.One patient whose△CBF was<0 and TTP was prolonged was diagnosed with a cerebral infarction,which was confirmed by postoperative CT.This group of patients recovered well by discharge,and none died.Conclusions CTP sensitively reflects the early changes in cerebral hemodynamics postoperatively,and is useful to assess cerebral autoregulatory function,predicted complications,such as hyperperfusion syndrome and cerebral infarction,which can be an important auxiliary means of monitoring during CEA.