經(jīng)顱多普勒超聲聯(lián)合經(jīng)顱彩色多普勒超聲評價(jià)基底動(dòng)脈狹窄支架置入療效及再狹窄因素的分析
發(fā)布時(shí)間：2018-11-21 17:39
【摘要】：目的聯(lián)合應(yīng)用經(jīng)顱多普勒超聲(TCD)及經(jīng)顱彩色多普勒超聲(TCCS)評估基底動(dòng)脈狹窄支架置入前后血流動(dòng)力學(xué)變化與術(shù)后再狹窄發(fā)生率及其危險(xiǎn)因素。方法回顧性連續(xù)收集2013年6月至2015年6月首都醫(yī)科大學(xué)宣武醫(yī)院神經(jīng)內(nèi)、外科重度癥狀性基底動(dòng)脈狹窄行支架置入術(shù)患者140例,均經(jīng)TCCS檢查及DSA證實(shí)。排除合并有顱外段椎動(dòng)脈、頸動(dòng)脈及鎖骨下動(dòng)脈重度狹窄影響基底動(dòng)脈血流動(dòng)力學(xué)評估及隨訪資料欠完整者,最終納入62例。檢查記錄術(shù)前、術(shù)后1個(gè)月內(nèi)及術(shù)后3、6、12個(gè)月基底動(dòng)脈狹窄段、椎動(dòng)脈顱內(nèi)段、大腦后動(dòng)脈(取較高側(cè)測值)的收縮期峰值流速(PSV)、舒張期末流速(EDV)、平均流速(MFV)與血管搏動(dòng)指數(shù)(PI)。比較術(shù)前、術(shù)后血流動(dòng)力學(xué)參數(shù)變化,分析再狹窄發(fā)生率及其影響因素。結(jié)果 (1)62例患者支架置入術(shù)后1個(gè)月內(nèi)基底動(dòng)脈PSV、EDV、MFV均較術(shù)前明顯下降[(119±50)cm/s比(232±54)cm/s、(52±26)cm/s比(124±40)cm/s、(74±33)cm/s比(160±43)cm/s,均P0.01],椎動(dòng)脈顱內(nèi)段PSV、EDV、MFV較術(shù)前明顯升高[(65±15)cm/s比(50±18)cm/s、(28±8)cm/s比(22±8)cm/s、(40±10)cm/s比(31±11)cm/s,均P0.01];54例后交通動(dòng)脈未開放的大腦后動(dòng)脈PSV、EDV、MFV及PI均較術(shù)前升高[(69±14)cm/s比(53±16)cm/s、(30±7)cm/s比(27±8)cm/s、(43±9)cm/s比(36±10)cm/s、(0.92±0.10)比(0.70±0.13),均P0.01]。(2)62例患者3、6、12個(gè)月累積再狹窄發(fā)生率分別為14.5%(9/62)、19.4%(12/62)、28.1%(16/49,失訪13例);應(yīng)用自膨式支架和球囊擴(kuò)張支架者12個(gè)月累積再狹窄發(fā)生率分別為22.2%(8/28,失訪8例)和35.3%(8/21,失訪5例),差異無統(tǒng)計(jì)學(xué)意義(χ2=0.335,P=0.563)。(3)COX回歸分析結(jié)果顯示,術(shù)后殘余狹窄、長段狹窄(10 mm)是發(fā)生再狹窄的獨(dú)立危險(xiǎn)因素(HR:5.989,95%CI:1.887~19.006,P=0.002;HR:5.079,95%CI:1.277~20.200,P=0.021)。結(jié)論通過TCD聯(lián)合TCCS檢測后循環(huán)各段動(dòng)脈PSV、EDV、MFV的變化可客觀評估基底動(dòng)脈支架置入的療效,是及時(shí)發(fā)現(xiàn)基底動(dòng)脈支架置入術(shù)后再狹窄的重要篩查手段。基底動(dòng)脈支架置入術(shù)后再狹窄發(fā)生率較高,術(shù)后殘余狹窄、長段狹窄是再狹窄發(fā)生的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective to evaluate the changes of hemodynamics and the incidence of restenosis and its risk factors before and after stent placement in basilar artery stenosis by transcranial Doppler (TCD) and transcranial color Doppler (TCCS). Methods 140 patients with severe symptomatic basilar artery stenosis underwent stenting in Xuanwu Hospital of Capital Medical University from June 2013 to June 2015. All patients were confirmed by TCCS and DSA. Exclusion of complicated with extracranial vertebral artery, severe stenosis of carotid artery and subclavian artery affecting hemodynamic evaluation of basilar artery and incomplete follow-up data were included in 62 cases. The peak systolic velocities of (PSV), end diastolic velocity (EDV),) were recorded before operation, 1 month after operation and 3 weeks after operation, 12 months after operation, intracranial segment of vertebral artery and posterior cerebral artery (taking higher side measurements). Mean Velocity (MFV) and Pulsatile Index (PI). The changes of hemodynamic parameters before and after operation were compared and the incidence of restenosis and its influencing factors were analyzed. Results (1) the PSV,EDV,MFV of basilar artery decreased significantly in 62 patients within 1 month after stent implantation [(119 鹵50) cm/s vs (232 鹵54) cm/s, vs (52 鹵26) cm/s vs (124 鹵40) cm/s,]. (74 鹵33) cm/s vs (160 鹵43) cm/s, and intracranial segment PSV,EDV,MFV of vertebral artery were significantly higher than those before operation [(65 鹵15) cm/s vs (50 鹵18) cm/s, (28 鹵8) cm/s vs (22 鹵8) cm/s,]. The ratio of (40 鹵10) cm/s to (31 鹵11) cm/s, was (P0.01). The PSV,EDV,MFV and PI of posterior cerebral artery in 54 patients with closed posterior communicating artery were higher than those before operation [(69 鹵14) cm/s vs (53 鹵16) cm/s, (30 鹵7) cm/s vs (27 鹵8) cm/s, (43 鹵9) cm/s vs (36 鹵10) cm/s,]. (0. 92 鹵0. 10) vs (0. 70 鹵0. 13), all P 0.01]. (2) the incidence of cumulative restenosis in 62 patients was 14. 5% (9 / 62), 19. 4% (12 / 62), 28. 1% (16 / 49), respectively. (13 cases); The incidence of cumulative restenosis in patients with self-expandable stent and balloon dilated stents was 22.2% (8 / 28, 8 / 8) and 35.3% (8 / 21, 5 cases), respectively. There was no significant difference (蠂 ~ 2 = 0.335). The results of COX regression analysis showed that residual stenosis and long segment stenosis (10 mm) were independent risk factors for restenosis (HR:5.989,95%CI:1.887~19.006,P=0.002;). HR:5.079,95%CI:1.277~20.200,P=0.021) Conclusion the changes of arterial PSV,EDV,MFV in each segment of circulation can be objectively evaluated by TCD combined with TCCS, and it is an important screening method to detect restenosis in time. The incidence of restenosis was higher after stent implantation. Residual stenosis and long segment stenosis were independent risk factors of restenosis.
【作者單位】： 首都醫(yī)科大學(xué)宣武醫(yī)院血管超聲診斷科;
【分類號】：R743;R445.1
本文編號：2347739
[Abstract]:Objective to evaluate the changes of hemodynamics and the incidence of restenosis and its risk factors before and after stent placement in basilar artery stenosis by transcranial Doppler (TCD) and transcranial color Doppler (TCCS). Methods 140 patients with severe symptomatic basilar artery stenosis underwent stenting in Xuanwu Hospital of Capital Medical University from June 2013 to June 2015. All patients were confirmed by TCCS and DSA. Exclusion of complicated with extracranial vertebral artery, severe stenosis of carotid artery and subclavian artery affecting hemodynamic evaluation of basilar artery and incomplete follow-up data were included in 62 cases. The peak systolic velocities of (PSV), end diastolic velocity (EDV),) were recorded before operation, 1 month after operation and 3 weeks after operation, 12 months after operation, intracranial segment of vertebral artery and posterior cerebral artery (taking higher side measurements). Mean Velocity (MFV) and Pulsatile Index (PI). The changes of hemodynamic parameters before and after operation were compared and the incidence of restenosis and its influencing factors were analyzed. Results (1) the PSV,EDV,MFV of basilar artery decreased significantly in 62 patients within 1 month after stent implantation [(119 鹵50) cm/s vs (232 鹵54) cm/s, vs (52 鹵26) cm/s vs (124 鹵40) cm/s,]. (74 鹵33) cm/s vs (160 鹵43) cm/s, and intracranial segment PSV,EDV,MFV of vertebral artery were significantly higher than those before operation [(65 鹵15) cm/s vs (50 鹵18) cm/s, (28 鹵8) cm/s vs (22 鹵8) cm/s,]. The ratio of (40 鹵10) cm/s to (31 鹵11) cm/s, was (P0.01). The PSV,EDV,MFV and PI of posterior cerebral artery in 54 patients with closed posterior communicating artery were higher than those before operation [(69 鹵14) cm/s vs (53 鹵16) cm/s, (30 鹵7) cm/s vs (27 鹵8) cm/s, (43 鹵9) cm/s vs (36 鹵10) cm/s,]. (0. 92 鹵0. 10) vs (0. 70 鹵0. 13), all P 0.01]. (2) the incidence of cumulative restenosis in 62 patients was 14. 5% (9 / 62), 19. 4% (12 / 62), 28. 1% (16 / 49), respectively. (13 cases); The incidence of cumulative restenosis in patients with self-expandable stent and balloon dilated stents was 22.2% (8 / 28, 8 / 8) and 35.3% (8 / 21, 5 cases), respectively. There was no significant difference (蠂 ~ 2 = 0.335). The results of COX regression analysis showed that residual stenosis and long segment stenosis (10 mm) were independent risk factors for restenosis (HR:5.989,95%CI:1.887~19.006,P=0.002;). HR:5.079,95%CI:1.277~20.200,P=0.021) Conclusion the changes of arterial PSV,EDV,MFV in each segment of circulation can be objectively evaluated by TCD combined with TCCS, and it is an important screening method to detect restenosis in time. The incidence of restenosis was higher after stent implantation. Residual stenosis and long segment stenosis were independent risk factors of restenosis.
【作者單位】： 首都醫(yī)科大學(xué)宣武醫(yī)院血管超聲診斷科;
【分類號】：R743;R445.1
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