单侧症状性颈内动脉闭塞再通治疗前后的超声评估

Ultrasound evaluation of unilateral symptomatic internal carotid artery occlusion before and after revascularization

目的探讨血管超声在评估单侧症状性颈内动脉闭塞(ICAO)患者再通治疗前后的临床价值。方法回顾性纳入2021年1月—2024年7月因单侧症状性ICAO在兰州大学第二医院接受血管再通治疗患者45例。根据再通治疗手术方式,分为颈动脉支架成形术(CAS)组32例,颈动脉内膜切除术(CEA)组13例。比较两组一般资料、血管再通率、术前与术后病变血管内径、侧支循环开放情况及患侧大脑中动脉(MCA)血流动力学参数变化。结果(1)45例患者血管再通率84.4%,CAS组与CEA组血管再通率分别为87.5%、76.9%,两组间差异无统计学意义(χ^(2)=0.188,P=0.665)。(2)两组再通患者治疗前后颈内动脉远段内径比较,CAS组(t=-5.217,P<0.001),CEA组(t=-5.056,P<0.001),差异有统计学意义。(3)两组术前侧支开放数量及类型组间差异无统计学意义(均P>0.05)。两组再通者患侧MCA收缩期血流速度及血管搏动指数与术前比较均恢复正常(P<0.001)。结论血管超声可用于评估单侧症状性ICAO患者再通治疗前后病变血管结构、血流动力学参数及侧支循环的变化,是血管再通治疗前后简便、可靠的评估手段。

Objective To investigate the clinical value of vascular ultrasound in evaluating patients with unilateral symptomatic internal carotid artery occlusion(ICAO)before and after revascularization.Methods A retrospective analysis was performed for 45 patients who underwent revascularization due to unilateral symptomatic ICAO in The Second Hospital of Lanzhou University from January 2021 to July 2024,and according to the surgical procedure for revascularization,they were divided into carotid artery stenting(CAS)group with 32 patients and carotid endarterectomy(CEA)group with 13 patients.The two groups were compared in terms of general data,revascularization rate,change in the inner diameter of diseased vessels after surgery,opening of collateral circulation,and changes in hemodynamic parameters of the affected middle cerebral artery(MCA)after surgery.Results The revascularization rate was 84.4%for all 45 patients,and there was no significant difference in revascularization rate between the CAS group and the CEA group(87.5%vs 76.9%,χ^(2)=0.188,P=0.665).Both groups had a significant change in the inner diameter of the distal internal carotid artery after treatment(the CAS group:t=-5.217,P<0.001;the CEA group:t=-5.056,P<0.001).There were no significant differences between the two groups in the number and type of collateral opening before surgery(all P>0.05).For both groups,systolic blood flow velocity and pulsatility index of the affected MCA returned to normal after surgery(P<0.001).Conclusion Vascular ultrasound can be used to evaluate the changes in the structure,hemodynamic parameters,and collateral circulation of diseased vessels after revascularization in patients with unilateral symptomatic ICAO,and it is a simple and reliable evaluation method before and after revascularization.