摘要
目的探讨颅内动脉瘤介入栓塞术后微栓子产生机制及其对预后的影响。方法前瞻性研究颈内动脉颅内段动脉瘤介入栓塞术患者,术后即刻采用经颅多普勒(TCD)仪监测微栓子30 min,术后3 d作头颅MR弥散加权成像(DWI)检查,分析术后微栓子产生机制及其对预后的影响。结果 2016年1月至2017年8月共有140例颈内动脉动脉瘤患者接受TCD监测。术后微栓子信号(MES)、DWI梗死灶阳性率分别为17.1%(24/140)、68.6%(96/140),24例MES阳性患者DWI梗死灶均阳性。13例(9.3%)DWI阳性患者出现围手术期缺血并发症,症状较轻(术后1周改良Rankin量表评分均≤2分),其中MES阳性9例。支架辅助栓塞患者MES阳性率显著高于单纯弹簧圈栓塞患者(25.8%对2.0%,χ~2=13.491,P<0.000 1)。缺血并发症与MES阳性、DWI梗死灶阳性均有相关性(Kendall相关系数分别为0.404、0.217,P<0.000 1、P=0.011),MES阳性与DWI梗死灶阳性也呈相关性(Pearson相关系数0.470,P<0.001)。结论支架辅助栓塞是颅内动脉瘤栓塞术后产生微栓子的主要危险因素。TCD微栓子监测可作为预测颅内动脉瘤栓塞术后缺血并发症的非侵入性、便捷、有效方法。
Objective To discuss the mechanism of microembolus formation after interventional embolization therapy for intracranial aneurysms and to analyze its influence on clinical outcome. Methods A prospective study on the mechanism of microembolus formation after interventional embolization therapy for intracranial aneurysms and its influence on clinical outcome was conducted. Monitoring of mieroemboli with transeranial Doppler （TCD） ultrasonography was carried out immediately after embolization procedure, and the monitoring lasted for 30 minutes. Three clays after embolization therapy MR diffusion-weighted imaging （DWI） of brain was performed to check the infarction lesions. The correlations between TCD and DWI findings were analyzed, and the mechanism of microembolus formation after interventional embolization therapy for intracranial aneurysms and its influence on clinical outcome were discussed. Results From January 2016 to August 2017, a total of 140 patients with internal carotid artery aneurysm underwent TCD monitoring for micoremboli. The positive incidence of microembolic signal （MES） and the positive incidence of infarction lesion on DWI were 17.1% （24/140） and 68.6% （96/140）, respectively. All the 24 patients with positive MES showed infarction lesions on DWI. Thirteen patients with positive DWI findings （9.3%） developed perioperative ischemic complications, although the symptoms were mild （one week after the treatment the modified Rankin scale score ≤2 points in all patients）. Nine among the 13 patients had positive MES. The positive rate of MES in patients receiving stent-assisted embolization was significantly higher than that in patients receiving embolization with coils only （25.8% vs 2.0%, χ^2=13.491 P〈0.000 1 ）. A parallel correlation existed between the ischemie complication and the positive MES as well as between the isehemic complication and the positive infarction lesion on DWI; the Kendall＇s correlation coefficients were 0.404 （P〈 0.000 1） and 0.217 （
作者
姚永治
权涛
管生
刘朝
李冬冬
陈振
徐浩文
YAO Yongzhi, QUAN Tao, GUAN Sheng, LIU Chao, LI Dongdong, CHEN Zhen, XU Haowen(Department of Neurointervention, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province 450052, Chin)
出处
《介入放射学杂志》
CSCD
北大核心
2018年第4期299-302,共4页
Journal of Interventional Radiology
关键词
微栓子信号
经颅多普勒
弥散加权成像
缺血并发症
颅内动脉瘤
microembolic signal
transcranial Doppler
diffusion-weighted imaging
ischemic complication
intracranial aneurysm
