摘要
目的探讨对大脑中动脉支架置入术患者使用经颅彩色多普勒超声(TCCS)评估颅内血流变化,初步探索大脑中动脉(MCA)成功置入后的彩色多普勒血流表现及血流动力学参数变化规律。方法纳入经我院脑血管造影术(DSA)明确诊断为MCA主干(M1段)重度狭窄、次全闭塞或闭塞并行支架置入术患者18例,于术前及术后1 d内分别进行1次床旁TCCS检查,使用彩色模式观察病变处MCA M1及其远段(M2段)血流束特点,使用频谱多普勒分别采集这两个血管节段的收缩期峰值流速(PSV)、舒张末期流速(EDV)、平均流速(MV)及搏动指数(PI)。结果18例患者中DSA确诊MCA M1段局限性重度狭窄13例,次全闭塞4例,闭塞1例。TCCS显示13例MCA M1段重度狭窄患者,其中1例术前病变侧MCA M1段血流束不连续,12例病变侧M1段血流束局部明显变细或呈长段线样狭窄;其中4例(4/13,30.8%)可见狭窄后扩张。13例患者均于狭窄处探及涡流频谱,血流速度增高,支架置入术后13例患者MCA M1段血流束粗细恢复较均匀一致,狭窄后扩张及涡流信号消失,血流速度较术前降低,术前、术后比较差异有统计学意义(P<0.05)。术后MCA M1段狭窄处与MCA M2段的PSV、EDV、MV流速比值均较术前明显降低,差异有统计学意义(P<0.05)。支架置入术后MCA M2段PI较术前明显增高,差异有统计学意义(P<0.05)。4例MCA M1段次全闭塞患者术前TCCS表现多样,可显示为长段纤细的血流束或走行区局部血流束中断、不连续,局部血流速度差异较大,但MCA M2段血流均呈“小慢波”改变。1例MCA M1段闭塞患者MCA M1及M2段血流束均未显示。MCA M1段次全闭塞及闭塞患者术后MCA M2的PI均明显升高。结论床旁TCCS安全、便捷,能快速评价MCA支架术后血流的改善状况,为临床提供支架后的详细血流动力学信息。
Objective To explore transcranial color-coded sonography(TCCS)to evaluate intracranial blood flow changes in patients undergoing middle cerebral artery stenting,and to explore preliminarily flow performance of TCCS and changing rules of hemodynamic parameters after successful stenting of middle cerebral artery(MCA).Methods 18 patients with severe stenosis,subtotal occlusion or occlusion of MCA M1 segment diagnosed by digital subtraction angiography(DSA)in our hospital were included.Beside TCCS examination was performed before and one day after surgery,respectively.Color mode was used to observe characteristics of blood flow in MCA M1 and M2.Spectral Doppler was used to collect blood parameters,including peak systolic flow velocity(PSV),end-diastolic flow velocity(EDV),mean flow velocity(MV)and pulsatile index(PI).Results Among 18 patients,13 cases of severe stenosis,4 cases of subtotal occlusion and 1 case of occlusion in MCA M1 segment were diagnosed by DSA.Among 13 patients with severe stenosis of MCA M1 segment,discontinuous blood flow was detected in 1 patient before surgery,partial or long stenosis was detected in 12 patients.Dilation after stenosis was showing in 4 patients(4/13,30.8%).The eddy current spectrum and increased blood flow velocity was detected at the stenosis site in all 13 patients.After stenting,blood flow of MCA M1 segment widening with the dilation and eddy current signals disappeared.Compared to before surgery,blood flow velocity decreased and there was a statistically significant difference between before and after surgery(P<0.05).The ratio of PSV,EDV and MV flow velocity between stenosis of MCA M1 segment and MCA M2 segment after surgery was reduced compared to before surgery,and there was statistical significance(P<0.05)in the comparison.The PI of MCA M2 segment was increased after stenting compared to before surgery,with statistical significance(P<0.05).Diverse TCCS manifestations were showing in 4 patients with MCA M1 segment subtotal occlusion,which could be displayed as long and sl
作者
周琛云
谭知芝
范红霞
胡发云
郑洪波
何英
罗燕
Zhou Chenyun;Tan Zhizhi;Fan Hongxia(Department of Ultrasound Medicine,Department of Neurology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China.)
出处
《四川医学》
CAS
2023年第9期952-956,共5页
Sichuan Medical Journal
关键词
大脑中动脉
支架置入术
彩色多普勒超声
经颅超声
床旁超声
middle cerebral artery
stenting
color-coded sonography
transcranial ultrasound
bedside ultrasound
