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目的采用彩色多普勒影像(CDFI)联合经颅多普勒超声(TCD)评价颈内动脉狭窄患者颈动脉支架置入术(CAS)的治疗效果。方法回顾性分析经数字减影血管造影(DSA)确诊具有脑缺血症状的中度颈内动脉狭窄且接受CAS治疗的患者35例,采用CDFI联合TCD方法测量CAS术前、术后颈内动脉狭窄局部管径、狭窄率、狭窄段收缩期峰值流速及同侧大脑中动脉的收缩期峰值流速、搏动指数进行对比分析,同时与DSA结果进行对比。结果颈内动脉狭窄患者行CAS术后原狭窄处管径明显增宽,原狭窄处血管内径由术前(1.82±0.75)mm增至术后(3.97±0.73)mm,P<0.001。颈内动脉狭窄处及患侧大脑中动脉的收缩期峰值流速、搏动指数恢复正常,94.3%侧支循环关闭。颈内动脉狭窄处收缩期峰值流速由术前(186.49±63.85)cm.s-1降至术后(80.63±31.46)cm.s-1,P<0.001;患侧大脑中动脉的收缩期峰值流速由术前(59.23±23.64)cm.s-1升至术后(85.5±20.59)cm.s-1,P<0.001;大脑中动脉的搏动指数值由术前(0.58±0.29)升至术后(0.83±0.17),P<0.001。结论 CDFI及TCD检测提示CAS术后颈内动脉狭窄处血管血流动力学及血管结构得到改善,CDFI联合TCD可以作为评价及随访CAS术后疗效的有效手段。
Objective To evaluate the therapeutic effect of carotid stenting (CAS) in patients with internal carotid artery stenosis by color Doppler imaging (CDFI) combined with transcranial Doppler ultrasound (TCD). Methods A retrospective analysis of 35 patients with moderate internal carotid artery stenosis confirmed by digital subtraction angiography (DSA) with cerebral ischemic symptoms and treated with CAS was performed. CDFI and TCD were used to measure the changes of internal carotid artery Stenosis rate, the peak systolic velocity of systole and the peak systolic velocity of systolic velocity and the pulsatility index of ipsilateral middle cerebral artery. Meanwhile, the results were compared with those of DSA. Results The diameter of the original stenosis in patients with internal carotid artery stenosis was significantly wider after CAS. The diameter of the original stenosis increased from 1.82 ± 0.75 mm to 3.97 ± 0.73 mm (P <0.001). The peak systolic velocity of internal carotid stenosis and ipsilateral middle cerebral artery returned to normal, with 94.3% of collateral circulation closed. The peak systolic velocity of systole at internal carotid artery narrowed from (186.49 ± 63.85) cm.sup.-1 to (80.63 ± 31.46) cm.s-1 preoperatively, P <0.001). The systolic peak of ipsilateral middle cerebral artery The mean arterial pressure increased from preoperative (59.23 ± 23.64) cm.sup.-1 to (85.5 ± 20.59) cm.s-1 postoperatively, P <0.001. The pulsatility index increased from 0.58 ± 0.29 Postoperatively (0.83 ± 0.17), P <0.001. Conclusions CDFI and TCD examination suggest that the hemodynamics and vascular structure of the internal carotid artery stenosis after CAS are improved. CDFI combined with TCD can be used as an effective method to evaluate and follow up the curative effect after CAS.