超声预测支架置入术后颈动脉扩张效果的价值
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摘要
目的探讨术前超声预测缺血性脑卒中患者颈动脉支架置入术(CAS)后颈动脉狭窄改善情况的方法与价值。方法回顾性分析CAS患者64例临床基线资料及术后1年颈动脉狭窄改善率(IRS)与术前12项颈动脉超声检测指标的皮尔逊积矩相关系数,并建立CAS后IRS的超声预测模型。结果术后1年无1例死亡。Pearson相关性分析显示,术后1年IRS与临床转归明显相关(P<0.01)。不稳定斑块积分比值(r=-0.520,P=0.000)、斑块最大偏心比值(r=-0.668,P=0.000)、最大责任斑块长度(r=-0.620,P=0.000)、最大责任斑块厚度(r=-0.563,P=0.000)、狭窄处收缩期峰值流速(r=-0.785,P=0.016)、阻力指数(r=-0.327,P=0.008)、颈动脉僵硬度指数(r=-0.811,P=0.000)与IRS呈负相关,搏动指数(r=0.363,P=0.003)、扩张系数(r=0.331,P=0.008)、顺应系数(r=0.306,P=0.014)与IRS呈正相关。逐步回归分析显示,患侧颈动脉僵硬度指数、狭窄处收缩期峰值流速及最大责任斑块厚度与CAS后IRS呈线性关系(P<0.01)。结论超声多指标联合对术前评估CAS后1年颈动脉狭窄改善情况有积极作用。
Objective To study the value of preoperative ultrasonography in predicting the improvement rate of CAS in ischemic stroke(IS)patients after stenting.Methods Sixty-four CAS patients were included in this study.Their baseline clinical data,improvement rate of CAS 1 year after stenting and Pearson matrix correlation coefficient of 12 carotid ultrasonographic indexes were retrospectively analyzed before stenting.An ultrasonographic prediction model of CAS improvement rate was established after stenting.Results No patient died 1 year after stenting.Pearson correlation analysis showed that the improvement rate of CAS was closely related with the clinical outcome of CAS patients 1 year after stenting(P<0.01).The integration ratios of unstable plaques,maximum plaque eccentricity,maximum plaque length,maximum plaque thickness,peak systolic flow rate in stenotic carotid artery,resistance index and carotid artery stiffness index were negatively related with the improvement rate of CAS after stenting(P<0.01).However,the pulsation index,dilation and compliance coefficient were positively related with the improvement rate of CAS after stenting(r=0.363,P=0.003;r=0.331,P=0.008;r=0.306,P=0.014).Stepwise regression analysis showed that carotid artery stiffness index,peak systolic flow rate in stenotic carotid artery and maximum plaque thickness were related with the improvement rate of CAS in a linear manner after stenting(P<0.01).Conclusion Ultrasonographic indexes play an active role in assessing the improvement rate of CAS 1 years after stenting.
Objective To study the value of preoperative ultrasonography in predicting the improvement rate of CAS in ischemic stroke(IS)patients after stenting.Methods Sixty-four CAS patients were included in this study.Their baseline clinical data,improvement rate of CAS 1 year after stenting and Pearson matrix correlation coefficient of 12 carotid ultrasonographic indexes were retrospectively analyzed before stenting.An ultrasonographic prediction model of CAS improvement rate was established after stenting.Results No patient died 1 year after stenting.Pearson correlation analysis showed that the improvement rate of CAS was closely related with the clinical outcome of CAS patients 1 year after stenting(P<0.01).The integration ratios of unstable plaques,maximum plaque eccentricity,maximum plaque length,maximum plaque thickness,peak systolic flow rate in stenotic carotid artery,resistance index and carotid artery stiffness index were negatively related with the improvement rate of CAS after stenting(P<0.01).However,the pulsation index,dilation and compliance coefficient were positively related with the improvement rate of CAS after stenting(r=0.363,P=0.003;r=0.331,P=0.008;r=0.306,P=0.014).Stepwise regression analysis showed that carotid artery stiffness index,peak systolic flow rate in stenotic carotid artery and maximum plaque thickness were related with the improvement rate of CAS in a linear manner after stenting(P<0.01).Conclusion Ultrasonographic indexes play an active role in assessing the improvement rate of CAS 1 years after stenting.
引文
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[14]蔡叶华,王涌,王怡,等.硬化参数β结合颈动脉内中膜厚度预测动脉粥样硬化性脑卒中的作用[J].上海交通大学学报(医学版),2017,37(5):666-669.DOI:10.3969/j.issn.1674-8115.2017.05.019.
[15]国家卫生计生委脑卒中防治工程委员会.中国脑卒中血管超声检查指导规范[J].中华医学超声杂志(电子版),2015,12(8):599-610.DOI:10.3877/cma.j.issn.1672-6448.2015.08.004.
[16]唐骁,郭大乔.颈动脉支架成形术后再狭窄的诊治策略[J].中国血管外科杂志(电子版),2015,7(2):73-75.DOI:10.3969/j.issn.1674-7429.2015.02.003.
[17]Xiong JQ,Yu C,Shi YW,et al.Morphological features of the internal carotid artery:advantages of combining linear and convex probes in duplex ultrasonography[J].Acad Radiol,2013,20(10):1240-1246.DOI:10.1016/j.acra.2012.08.018.
[2]Egron S,Kütting M,Marzelle J,et al.What can be done for cerebral embolic protection in TAVI?Analysis in the light of10yearsexperience with protected carotid artery stenting[J].Expert Rev Med Devices,2016,13(1):15-29.DOI:10.1586/17434440.2015.1120666.
[3]Nakagawa N,Fukawa N,Tsuji K,et al.Urgent carotid artery stenting for carotid-related stroke-in-evolution[J].Oper Neurosurg(Hagerstown),2018,14(1):9-15.DOI:10.1093/ons/opx073.
[4]Nejim B,Dakour Aridi H,Locham S,et al.Carotid artery revascularization in patients with contralateral carotid artery occlusion:stent or endarterectomy[J]?J Vasc Surg,2017,66(6):1735-1748.DOI:10.1016/j.jvs.2017.04.055.
[5]Lu J,Wang D.Advances in endovascular therapy for ischemic cerebrovascular diseases[J].Chronic Dis Transl Med,2016,2(3):135-139.DOI:10.1016/j.cdtm.2016.11.005.
[6]王陇德,王金环,彭斌,等.《中国脑卒中防治报告2016》概要[J].中国脑血管病杂志,2017,14(4):217-227.DOI:10.3969/j.issn.1672-5921.2017.04.010.
[7]Timaran CH,Veith FJ,Rosero EB,et al.Intracranial hemorrhage after carotid endarterectomy and carotid stenting in the United States in 2005[J].J Vasc Surg,2009,49(3):623-628.DOI:10.1016/j.jvs.2008.09.064.
[8]马康孝.颈动脉支架成形术和颈动脉内膜剥脱术治疗颈动脉狭窄的早期并发症比较[J].陕西医学杂志,2014,43(10):1317-1318.DOI:10.3969/j.issn.1000-7377.2014.10.021.
[9]郝俊海,马顺昌,满韦韬,等.颈动脉支架置入术后再狭窄的防治研究进展[J].中华神经外科杂志,2015,31(5):539-540.DOI:10.3760/cma.j.issn.1001-2346.2015.05.031.
[10]Sibley CT,Vavere AL,Gottlieb I,et al.MRI-measured regression of carotid atherosclerosis induced by statins with and without niacin in a randomised controlled trial:the NIA plaque study[J].Heart,2013,99(22):1675-1680.DOI:10.1136/heartjnl-2013-303926.
[11]Müller MD,Ahlhelm FJ,von Hessling A,et al.Vascular anatomy predicts the risk of cerebral ischemia in patients randomized to carotid stenting versus endarterectomy[J].Stroke,2017,48(5):1285-1292.DOI:10.1161/STROKEAHA.116.014612.
[12]樊文峰,刘文聪,刘文宣,等.彩超直径法和血流速度法评价颈动脉狭窄的临床价值研究[J].河北医药,2016,38(10):1468-1470.DOI:10.3969/j.issn.1002-7386.2016.10.007.
[13]严子君,张瑞岩,左君丽,等.大动脉僵硬度对不良心血管事件的预测价值[J].中华老年心脑血管病杂志,2014,16(8):788-791.DOI:10.3969/j.issn.1009-0126.2014.08.002.
[14]蔡叶华,王涌,王怡,等.硬化参数β结合颈动脉内中膜厚度预测动脉粥样硬化性脑卒中的作用[J].上海交通大学学报(医学版),2017,37(5):666-669.DOI:10.3969/j.issn.1674-8115.2017.05.019.
[15]国家卫生计生委脑卒中防治工程委员会.中国脑卒中血管超声检查指导规范[J].中华医学超声杂志(电子版),2015,12(8):599-610.DOI:10.3877/cma.j.issn.1672-6448.2015.08.004.
[16]唐骁,郭大乔.颈动脉支架成形术后再狭窄的诊治策略[J].中国血管外科杂志(电子版),2015,7(2):73-75.DOI:10.3969/j.issn.1674-7429.2015.02.003.
[17]Xiong JQ,Yu C,Shi YW,et al.Morphological features of the internal carotid artery:advantages of combining linear and convex probes in duplex ultrasonography[J].Acad Radiol,2013,20(10):1240-1246.DOI:10.1016/j.acra.2012.08.018.