MSCTA在颈动脉血管支架植入术前后颈动脉狭窄程度评估中的应用

Application of MSCTA in the Evaluation of Carotid Artery Stenosis Degree before and after Carotid Artery Stenting

目的评价多层螺旋CT血管造影(MSCTA)在颈动脉血管支架植入术(CAS)前后颈动脉狭窄程度评估中的应用价值。方法回顾性分析2020年2月至2023年11月在我院行CAS治疗的82例患者临床资料,所有患者均在术前、术后进行MSCTA检查评估颈动脉狭窄程度,比较患者术前、术后颈动脉狭窄程度变化,以数字减影血管造影(DSA)为金标准评估MSCTA在不同颈动脉狭窄程度患者颈动脉狭窄程度评估中的诊断价值。结果82例颈动脉狭窄患者,其中左、右侧颈内动脉狭窄29例、41例,双侧颈内动脉狭窄12例,CAS治疗血管共94支,手术均成功;MSCTA结果显示,CAS术前94支血管以中、重度为主,占比82.98%,部分血管闭塞,占比13.83%,CAS术后以轻度狭窄为主,占比92.55%,部分患者为中度狭窄,占比7.45%,无重度狭窄和闭塞患者,82例患者CAS治疗前后颈动脉狭窄程度分布差异有统计学意义(P<0.05);CAS术前,MSCTA评估轻、中、重度颈动脉狭窄和颈动脉闭塞的灵敏度分别为0.00%、77.08%、90.62%、85.71%,特异度分别为96.80%、90.38%、88.701%、98.75%,准确率分别为96.80%、84.00%、89.36%、96.80%,与DAS结果比较,kappa值分别为0、0.678、0.770、0.870;CAS术后,MSCTA评估轻、中度颈动脉狭窄和颈动脉闭塞的灵敏度分别为92.55%、0.00%,特异度分别为0.00%、92.55%,准确率均为92.55%,与DAS结果比较,kappa值均为0,MSCTA评估重度颈动脉狭窄和颈动脉闭塞结果均与DAS结果一致。结论MSCTA在CAS术前后颈动脉狭窄程度的评估中具有较好的应用价值。

Objective To evaluate the application value of multi-slice spiral CT angiography(MSCTA)on the evaluation of carotid artery stenosis degree before and after carotid artery stenting(CAS).Methods The clinical data of 82 patients who underwent CAS in our hospital were retrospectively analyzed from February 2020 to November 2023.All patients underwent MSCTA examination before and after surgery to evaluate the degree of carotid artery stenosis.The changes of carotid artery stenosis degree before and after surgery were compared.The diagnostic value of MSCTA on evaluating carotid artery stenosis degree in patients with different degrees of carotid artery stenosis was evaluated by taking digital subtraction angiography(DSA)as the gold standard.Results Among the 82 patients with carotid artery stenosis,there were 29 cases of left internal carotid artery stenosis,41 cases of right internal carotid artery stenosis and 12 cases of bilateral internal carotid artery stenosis.94 vessels were treated with CAS,and all surgeries were successful.MSCTA results showed that 94 vessels before CAS were mainly moderate and severe,accounting for 82.98%,and some vessels were occluded,accounting for 13.83%.After CAS,patients were mainly mild stenosis(92.55%)and some patients were moderate stenosis(7.45%),and there were no patients with severe stenosis and occlusion.There was a statistically significant difference in the distribution of carotid artery stenosis before and after CAS among 82 patients(P<0.05).Before CAS,the sensitivities of MSCTA in evaluating mild,moderate and severe carotid artery stenosis and carotid artery occlusion were 0.00%,77.08%,90.62%and 85.71%,the specificities were 96.80%,90.38%,88.701%and 98.75%,the accuracy rates were 96.80%,84.00%,89.36%and 96.80%,and the kappa values with DAS results were 0,0.678,0.770 and 0.870 respectively.After CAS,the sensitivities of MSCTA in assessing mild and moderate carotid artery stenosis and carotid artery occlusion were 92.55%and 0.00%,the specificities were 0.00%and 92.55%,and the accuracy rates were 92.55%and 92.55%,and the kappa values with DAS results were 0 and 0,and the results of MSCTA in evaluating severe carotid artery stenosis and carotid artery occlusion were consistent with the DAS results.Conclusion MSCTA has good application value on evaluating carotid artery stenosis degree before and after CAS.