【摘要】：目的： 通過(guò)頸動(dòng)脈高分辨率磁共振掃描,分析頸動(dòng)脈斑塊性質(zhì),預(yù)測(cè)頸動(dòng)脈支架成形術(shù)(Carotid artery stenting, CAS)中病變部位可能脫落的有害栓子。結(jié)合患者的危險(xiǎn)因素及CAS術(shù)中捕捉到的栓子,計(jì)算有害栓子發(fā)生的概率,為CAS中合理使用栓子保護(hù)裝置(embolic-protected devices, EPDs)提供可靠依據(jù)。 方法：收集2010年10月～2013年12月山東大學(xué)附屬省立醫(yī)院行頸動(dòng)脈支架置入術(shù)(Carotid artery stenting, CAS)的患者195名,CAS前行頸動(dòng)脈高分辨率磁共振掃描,明確頸動(dòng)脈斑塊的性質(zhì)(穩(wěn)定斑塊或易損斑塊),術(shù)中所有患者均使用栓子保護(hù)裝置,術(shù)后根據(jù)保護(hù)裝置中捕捉到的斑塊的大小、數(shù)量將栓子分為A、B、C、D四種類型(A類：保護(hù)裝置中未見栓子；B類：保護(hù)裝置中栓子直徑2mm,數(shù)量上n≤2；C類：保護(hù)裝置中栓子直徑2mm,數(shù)量上n≥3；D類：保護(hù)裝置中栓子直徑2mm,數(shù)量上n≥1)。根據(jù)收集栓子的情況將病人分為兩組：無(wú)害栓子組(W組：A類和B類)和有害栓子組(Y組：C類和D類)。依次對(duì)病人的特征、病史等進(jìn)行比較分析,得出有害栓子發(fā)生的危險(xiǎn)因素。根據(jù)統(tǒng)計(jì)數(shù)據(jù),計(jì)算易損斑塊合并不同數(shù)量的危險(xiǎn)因素時(shí),有害栓子發(fā)生的概率。 結(jié)果： 經(jīng)頸動(dòng)脈高分辨率MRI檢測(cè)顯示,195例患者中116例為穩(wěn)定斑塊(59.5%),79例為易損斑塊(40.5%)。195名患者均成功實(shí)施頸動(dòng)脈支架成形術(shù),術(shù)中均使用栓子保護(hù)裝置。CAS術(shù)后Y組包含58名患者,W組包含137名患者。Logistic回歸分析顯示：年齡(P=0.0465)、狹窄長(zhǎng)度(P=0.0475)、吸煙(P=0.0172)以及術(shù)前TIA發(fā)作≥3次(P=0.0102)均是有害栓子脫落的危險(xiǎn)因素。2例(3.4%)有害栓子來(lái)自穩(wěn)定斑塊,56例(96.6%)有害栓子來(lái)自易損斑塊。且當(dāng)易損斑塊合并0項(xiàng)危險(xiǎn)因素時(shí),有害栓子的發(fā)生率為：44%。當(dāng)易損斑塊合并1項(xiàng)危險(xiǎn)因素時(shí),有害栓子的發(fā)生率為：68.1%。當(dāng)易損斑塊合并2項(xiàng)危險(xiǎn)因素時(shí),有害栓子的發(fā)生率為：72.2%。當(dāng)易損斑塊合并3項(xiàng)危險(xiǎn)因素時(shí),有害栓子的發(fā)生率為：76.5%。當(dāng)易損斑塊合并4項(xiàng)危險(xiǎn)因素時(shí),有害栓子的發(fā)生率為：84.6%。 結(jié)論： 穩(wěn)定斑塊在CAS中有害栓子發(fā)生率很低(1.7%)。易損斑塊合并越多數(shù)量的危險(xiǎn)因素,CAS中有害栓子發(fā)生率越高。當(dāng)頸動(dòng)脈斑塊為穩(wěn)定斑塊時(shí),可以考慮不再使用栓子保護(hù)裝置。當(dāng)頸動(dòng)脈斑塊為易損斑塊時(shí),建議使用栓子保護(hù)裝置。
[Abstract]:Objective: to analyze the character of carotid plaque by high resolution magnetic resonance imaging (MRI) of carotid artery, and to predict the harmful embolus which may fall off in carotid stent-angioplasty (Carotid artery stenting, CAS). Combined with the risk factors of patients and the embolus captured during CAS operation, the probability of occurrence of harmful emboli was calculated, which provided a reliable basis for the rational use of emboli protection device (embolic-protected devices, EPDs) in CAS. Methods: from October 2010 to December 2013, 195 patients with carotid artery stenting (Carotid artery stenting, CAS) underwent carotid artery high-resolution magnetic resonance imaging (HRMRI) in the Provincial Hospital affiliated to Shandong University. To determine the nature of carotid plaques (stable or vulnerable plaques), all patients were treated with embolus protection devices, and the size of the plaques captured in the protective devices was determined after the operation. The number of emboli was divided into four types: type A: there was no embolus B in the protective device, the diameter of the emboli in the protective device was 2mm, the quantity was n 鈮，

本文編號(hào)：2233840