3D-DSA与Dyna-CT在颅内支架置入术中的临床应用研究

Clinical Application of 3D-DSA and DynaCT in Intracranial Stent Placement

目的探讨三维DSA血管成像(3D-DSA)及数字平板造影机的C臂旋转并断层重建技术(DynaCT)在颅内支架置入术患者中的临床应用。方法选择2019年1月-2020年6月厦门大学附属中山医院收治92例颅内动脉狭窄患者,所有患者均行颅内支架置入术治疗,分为对照组(n=38例)和观察组(n=54例)。对照组采用3D-DSA引导,观察组采用DynaCT引导,术后进行12个月门诊随访,比较两组改良Rankin量表(mRS)评分、手术成功率、并发症、支架再狭窄及斑块检出率。结果观察组术后4个月、8个月及12个月mRS评分、支架成形术耗时低于对照组(P<0.05);观察组Dyna-CT的术前规划、观察到支架表面图像与术中所见吻合,手术成功率为83.33%,高于对照组63.16%(P<0.05);两组围术期并发症发生率无统计意义(P>0.05);观察组手术后进行12个月门诊随访,患者支架再狭窄、血管狭窄部位斑块检出率低于对照组(P<0.05)。结论DynaCT用于颅内支架置入术中能改善患者症状,缩短支架成形术耗时,有助于提高手术成功率,未增加并发症发生率,能降低血管狭窄部位斑块检出率,值得推广应用。

Objective To explore the clinical application of three-dimensional DSA angiography(3D-DSA)and C-arm rotation and tomographic reconstruction technology(Dyna-CT)of digital flat plate imaging machine in patients undergoing intracranial stent implantation.Methods A total of 92 patients with intracranial artery stenosis admitted to Zhongshan Hospital affiliated with Xiamen University from January 2019 to June 2020 were selected.All patients underwent intracranial stent implantation and were divided into a control group(n=38 cases)and an observation group(n=54 cases).The control group was guided by 3D-DSA,while the observation group was guided by Dyna-CT.A 12 month outpatient followup was conducted after surgery to compare the modified Rankin scale(mRS)scores,surgical success rates,complications,stent restenosis,and plaque detection rates between the two groups.Results The observation group had lower mRS scores and shorter stent reconstruction time at 4,8,and 12 months after surgery compared to the control group(P<0.05);The preoperative planning and observation of stent surface images in Dyna-CT observation group were consistent with intraoperative findings,with a surgical success rate of 83.33%,which was higher than 63.16%in the control group(P<0.05);There was no statistically significant difference in the incidence of perioperative complications between the two groups(P>0.05);The observation group underwent 12 months of outpatient follow-up after surgery,and the detection rate of plaque in stent restenosis and vascular stenosis sites in patients was lower than that in the control group(P<0.05).Conclusion Dyna-CT used in intracranial stent implantation can improve patient symptoms,shorten the time required for stenting,and help improve the success rate of surgery.It does not increase the incidence of complications and can reduce the detection rate of plaque in vascular stenosis sites.It is worth promoting and applying.