不同影像检查方法对颈动脉内膜切除术与颈动脉支架植入术后颈动脉狭窄程度的诊断价值

Diagnostic value of different imaging examination for the degree of carotid artery stenosis after carotid endarterectomy and carotid artery stenting

目的 探讨不同影像检查方法对颈动脉内膜切除术(CEA)与颈动脉支架植入术(CAS)后颈动脉狭窄程度的诊断价值。方法 收集2018年2月到2020年1月承德医学院附属医院行CEA或CAS的98例颈动脉狭窄患者的临床资料,按照治疗方式的不同将其分为CEA组(n=48)和CAS组(n=50)。比较两组患者手术前后颈动脉狭窄程度及住院期间至随访2年内不良心血管事件发生率。以头颈主动脉弓机断层扫描血管成像(CTA)为诊断金标准,比较彩色多普勒超声、磁共振成像检查颈动脉狭窄程度的准确度。结果 手术前后,两组患者颈动脉狭窄各程度比较,差异均无统计学意义(P﹥0.05)。术后,两组患者中、重度颈动脉狭窄均低于本组术前,差异均有统计学意义(P﹤0.05)。CEA组患者不良心血管事件总发生率为2.08%(1/48),与CAS组患者的4.00%(2/50)比较,差异无统计学意义(P﹥0.05)。彩色多普勒超声检查颈动脉狭窄程度准确度为95.92%(94/98),与磁共振成像检查的94.90%(93/98)比较,差异无统计学意义(P﹥0.05)。结论 彩色多普勒超声和磁共振成像检查对颈动脉狭窄程度的诊断准确度均较高,CEA、CAS治疗颈动脉狭窄均具有较好疗效,且术后不良心血管事件发生率较低。

Objective To explore the diagnostic value of different imaging methods in the degree of carotid artery stenosis after carotid endarterectomy(CEA)and carotid artery stenting(CAS).Method The clinical data of 98 patients with carotid artery stenosis who underwent CEA or CAS in the Affiliated Hospital of Chengde Medical College from February 2018 to January 2020 were collected and divided into CEA group(n=48)and CAS group(n=50)according to different treatment methods.The degree of carotid artery stenosis before and after operation and the incidence of adverse cardiovascular events from hospitalization to 2 years of follow-up were compared between the two groups.The head and neck aortic arch of computer tomography angiography(CTA)was used as the gold standard,the accuracy of color Doppler ultrasound and magnetic resonance imaging in diagnosing the degree of carotid artery stenosis was compared.Result Before and after operation,there was no significant difference in the degree of carotid artery stenosis between the two groups(P>0.05).After operation,the moderate and severe carotid artery stenosis of the two groups were lower than those before operation,the differences were statistically significant(P<0.05).The total incidence of adverse cardiovascular events in CEA group was 2.08%(1/48),which was not statistically significant compared with 4.00%(2/50)in CAS group(P>0.05).The accuracy of color Doppler ultrasonography for carotid artery stenosis was 95.92%(94/98),compared with 94.90%(93/98)of magnetic resonance imaging examination,there was no significant difference(P>0.05).Conclusion Both color Doppler ultrasonography and magnetic resonance imaging have high diagnostic accuracy for the degree of carotid artery stenosis.CEA and CAS have high efficacy in the treatment of carotid artery stenosis,and the incidence of postoperative adverse cardiovascular events is low.