發(fā)布時(shí)間：2018-06-23 16:39

  本文選題：頸動(dòng)脈狹窄 + 支架成形術(shù)��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:利用血管內(nèi)超聲(IntravascularUltrasound,IVUS)對(duì)頸動(dòng)脈粥樣硬化斑塊進(jìn)行定性、定量分析,并指導(dǎo)和評(píng)價(jià)頸動(dòng)脈支架置入的效果,探討血管內(nèi)超聲在頸動(dòng)脈狹窄診治中的應(yīng)用意義。方法:采用前瞻性病例對(duì)照研究,納入2014年7月至2016年4月于我院神經(jīng)內(nèi)科住院的患者12例,通過全腦數(shù)字減影血管造影(Digital Subtraction Angiography,DSA)檢查確診為頸動(dòng)脈中度或重度狹窄,并獲取影像學(xué)資料,測(cè)得頸動(dòng)脈狹窄最嚴(yán)重處斑塊總數(shù)、偏心性斑塊數(shù)目以及管腔最窄處的直徑、病變血管近遠(yuǎn)端正常血管直徑;對(duì)符合頸動(dòng)脈支架成形術(shù)適應(yīng)癥的患者,于支架前行IVUS檢查,觀察頸動(dòng)脈狹窄處管腔及血管壁情況,測(cè)得狹窄最嚴(yán)重處斑塊總數(shù)、偏心性斑塊數(shù)目以及管腔最窄處血管橫截面的總面積及管腔面積。支架置入后行DSA和IVUS檢查,復(fù)測(cè)支架置入后最窄處管腔的直徑、管腔最窄處血管橫截面的總面積及管腔面積,并觀察支架后展開及貼壁情況,評(píng)價(jià)支架置入的效果,對(duì)兩組檢查方法所得出的結(jié)果進(jìn)行對(duì)比分析。結(jié)果:12例患者的IVUS灰階圖像顯示:頸總動(dòng)脈呈單層結(jié)構(gòu),頸內(nèi)動(dòng)脈均為三層結(jié)構(gòu),頸動(dòng)脈狹窄最嚴(yán)重處斑塊性質(zhì)分別是:纖維斑塊5處,纖維脂質(zhì)斑塊2處,鈣化、混合斑塊分別為3處、2處。病變血管中DSA觀察到偏心性病變占23.5%,IVUS觀察到偏心病變占為56.5%,兩種檢查方法比較有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。支架置入術(shù)前DSA測(cè)得直徑狹窄率為(66.08±5.84)%,IVUS測(cè)得面積狹窄率為(86.92±6.26)%,兩者有顯著統(tǒng)計(jì)學(xué)差異(P0.01);支架置入術(shù)后DSA測(cè)得直徑狹窄率為(12.75±4.88)%,IVUS測(cè)得面積狹窄率為(19.25±5.31)%,兩者也有顯著統(tǒng)計(jì)學(xué)差異(P0.01)。12例患者頸動(dòng)脈支架置入均獲得成功,術(shù)中及圍手術(shù)期無并發(fā)癥產(chǎn)生。術(shù)中7例支架后DSA提示殘余狹窄30%,其IVUS均顯示展開不良,它們存在貼壁不好,其中4例有支架對(duì)稱性不好,予以球囊擴(kuò)張后,IVUS均顯示病變段血管得到充分?jǐn)U張、支架對(duì)稱性與貼壁良好,其它5例殘余狹窄30%的患者支架后IVUS檢查均存在不同程度的貼壁欠佳的現(xiàn)象,無對(duì)稱不良者。結(jié)論:IVUS能較為準(zhǔn)確的判定粥樣硬化斑塊的性質(zhì),對(duì)病變部位的狹窄程度的判定較DSA更精確,對(duì)支架置入的即時(shí)效果評(píng)價(jià)較DSA更準(zhǔn)確,可指導(dǎo)血管內(nèi)介入治療。
[Abstract]:Objective: to evaluate the value of intravascular ultrasound (IVUS) in the diagnosis and treatment of carotid artery stenosis by using intravascular ultrasound (IVUS) for qualitative and quantitative analysis of carotid atherosclerotic plaque, and to guide and evaluate the effect of carotid stent implantation. Methods: a prospective case-control study was conducted in 12 patients admitted to the Department of Neurology from July 2014 to April 2016. The carotid artery stenosis was diagnosed by digital subtraction angiography (DSA). Imaging data were obtained to determine the total number of plaques in the most severe carotid stenosis, the number of eccentric plaques and the diameter of the narrowest part of the lumen, and the diameter of the proximal and distal normal vessels of the diseased vessels. Before stenting, IVUS was performed to observe the lumen and wall of carotid artery stenosis. The total number of plaques, the number of eccentric plaques and the total area and lumen area of the vessel cross section at the narrowest part of the lumen were measured. After stent placement, DSA and IVUS were performed. The diameter of the narrowest lumen, the total area and the lumen area of the narrowest vessel in the stent were measured, and the expansion and adhesion of the stent were observed to evaluate the effect of stent placement. The results of the two groups were compared and analyzed. Results the gray-scale IVUS images of 12 patients showed that the common carotid artery was monolayer, and the internal carotid artery had a three-layer structure. The most severe carotid artery stenosis was found in 5 fibrous plaques, 2 fibrous lipid plaques, and calcification. The mixed plaques were 3 sites and 2 sites respectively. The percentage of eccentric lesions observed by DSA and IVUS was 56.5, and there was significant difference between the two methods (P0.05). The diameter stenosis rate measured by DSA before stent implantation was (66.08 鹵5.84) and the area stenosis rate measured by IVUS was (86.92 鹵6.26), there was significant difference between the two groups (P0.01), the diameter stenosis rate measured by DSA after stent implantation was (12.75 鹵4.88) and the area stenosis rate measured by IVUS was (19.25 鹵5.31). The carotid stents were successfully implanted in 12 patients (P0.01). No complications occurred during and around the operation. In 7 cases, DSA showed residual stenosis 30%, IVUS was not well developed, and there was poor adherence to the stent in 4 cases. After balloon dilatation, IVUS showed that the lesion vessels were fully dilated. The symmetry and adhesion of stents were good. IVUS examination of other 5 patients with 30% residual stenosis had different degree of poor adherence to the stents, but not symmetrical ones. ConclusionVIVUS is more accurate in judging the nature of atherosclerotic plaque, and more accurate in judging the degree of stenosis of lesion than DSA. The immediate evaluation of stent implantation is more accurate than that of DSA, and it can be used as a guide for intravascular interventional therapy.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
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本文編號(hào)：2057726