颈内动脉闭塞病变管腔结构和血流动力学特征分析

Lumen structure and hemodynamic characteristics of occluded internal carotid artery

目的应用颈动脉多普勒超声联合经颅彩色多普勒超声评估急性期和慢性期颈内动脉闭塞(ICAO)的管腔结构特征及颅内、外血流动力学变化特征。方法回顾性连续纳入自2017年9月至2021年10月首都医科大学宣武医院神经内科或神经外科因ICAO相关的脑梗死住院的患者。根据病程将ICAO患者分为急性期组(≤4周)和慢性期组(>4周)。应用颈动脉多普勒超声与经颅彩色多普勒超声对ICAO患者颈动脉管腔结构特征与颅内、外动脉血流动力学参数进行联合检测,并比较急性期组与慢性期组的特征参数,采用单因素及Logistic多因素回归分析ICAO急性期病程的相关危险因素。结果386例ICAO患者被纳入研究,急性期组165例,慢性期组221例。急性期组女性占13.3%,高于慢性期组的6.8%(P=0.031)。急性期组冠心病患者占26.1%,高于慢性期组的16.3%(P=0.019)。急性期组颈动脉斑块以低回声为主占73.3%,高于慢性期组的58.4%(P=0.002)。急性期组患侧大脑中动脉平均搏动指数为0.61±0.12,低于慢性期组的0.63±0.14(P=0.037)。Logistic多因素回归分析显示,患者为女性(OR值:2.124,95%CI:1.042~4.331,P=0.038)、冠心病病史(OR值:2.063,95%CI:1.227~3.470,P=0.006)、斑块以低回声为主(OR值:2.093,95%CI:1.332~3.291,P=0.001)、患侧大脑中动脉血管搏动指数低(OR值:0.183,95%CI:0.036~0.930,P=0.041)是ICAO患者急性期病程的独立危险因素。结论急性期和慢性期颈内动脉闭塞的管腔结构特征和颅内血流动力学特征不同。颈动脉多普勒超声联合经颅彩色多普勒超声可以评估患者病变特点,从而有助于临床治疗决策。

Objective To investigate the characteristics of lumen structure and intracranial and extracranial hemodynamic parameters in patients with internal carotid artery occlusion(ICAO)in acute and chronic stages by combining carotid Doppler ultrasound(CDU)and transcranial color Doppler(TCCD).Methods Patients admitted to the Department of Neurology or Neurosurgery of Xuanwu Hospital of Capital Medical University due to ICAO-related cerebral infarction from September 2017 to October 2021 were retrospectively and consecutively enrolled.According to the course of disease,the ICAO patients were divided into acute(≤4 weeks)and chronic(>4 weeks)groups.CDU and TCCD were used to detect the carotid lumen structure and intracranial and external arterial blood flow parameters in ICAO patients.The characteristic parameters were compared between the acute stage group and chronic stage group.The risk factors related to the acute course of ICAO were identified by univariate and Logistic regression analyses.Results A total of 386 ICAO-related cerebral infarction patients were included,including 165 in the acute stage group and 221 in the chronic stage group.The proportion of women in the acute stage group was 13.3%,higher than that of the chronic phase group(6.8%,P=0.031).The incidence of coronary heart disease in the acute stage group was 26.1%,which was higher than that of the chronic stage group(16.3%,P=0.019).The proportion of hypoechoic plaques in the acute phase group was higher than that of the chronic stage group(73.3%vs 58.4%,P=0.002).The mean pulsatility index of the middle cerebral artery in the acute stage group was 0.61±0.12,which was lower than that of the chronic phase group(0.63±0.14,P=0.037).Logistic multivariate regression analysis demonstrated that female gender(odds ratio[OR]:2.124,95%confidence interval[CI]:1.042-4.331,P=0.038),history of coronary heart disease(OR:2.063,95%CI:1.227-3.470,P=0.006),mainly hypoechoic plaques(OR:2.093,95%CI:1.332-3.291,P=0.001),and low pulsatility index of the affected middle cerebral artery(OR:0.183,95%CI:0.036-0.930,P=0.041)were independent risk factors for the acute course of ICAO patients.Conclusions The characteristics of lumen structure and intracranial hemodynamics are different between patients with acute and chronic ICAO.CDU combined with TCCD can evaluate the characteristics of patients'lesions and help clinicians make treatment decisions.