血管内超声在1例颈内动脉闭塞患者介入治疗中的应用
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摘要
目的探讨血管内超声(IVUS)技术在颈内动脉闭塞经皮腔内血管成形术(PTA)中的应用价值。方法 1例患者CTA明确颈内动脉闭塞,脑灌注成像见低灌注区与缺血相关症状符合,在IVUS导引下接受PTA治疗。采用微导丝及微导管同轴技术通过闭塞段,IVUS确认位于真腔内,微导管造影确认闭塞远端血管通畅,调整后放置栓塞保护器;IVUS测评斑块及管腔情况,球囊预扩张后再次测评;血管内恢复正向血流后通过IVUS虚拟组织学序列分析斑块稳定性,斑块纤维帽稳定且管腔狭窄率<40%仅作单纯球囊扩张治疗。结果单纯球囊扩张治疗后闭塞血管再通,恢复正向血流。IVUS全程检测狭窄段斑块纤维帽稳定,管腔狭窄率<40%,脑灌注成像显示低灌注状态明显改善。结论 IVUS技术在PTA治疗颈内动脉闭塞中起重要导引作用,可增加再通手术成功率,降低并发症发生率。
Objective To discuss the clinical value of intravascular ultrasound(IVUS) in treating internal carotid arteries occlusion. Methods The patient was diagnosed with internal carotid artery occlusion that was confirmed by CTA. Cerebral perfusion imaging showed that low perfusion area was consistent with ischemic symptoms. Guided by IVUS, percutaneous transluminal angioplasty(PTA) was performed. By using micro-catheter coaxial technology, the micro guide wire was inserted in the carotid artery until it passed through the obstructed segment; After IVUS examination proved that the micro guide wire was in the true lumen of carotid artery, angiography through micro-catheter was carried out to confirm that the distal artery was unobstructed; after adjusting the device position the embolism protector was placed. The plaque and lumen condition were assessed with IVUS, which was reevaluated after pre-expansion of balloon. After normal direction blood flow was regained, the plaque stability was assessed with IVUS virtual organization sequence.Simple balloon dilatation therapy was adopted as the fibrous cap of plaque was in stable condition and the lumen stenosis rate was <40%. Results After balloon dilatation, the obstructed artery was reopened and the blood flow regained normal direction. IVUS examination showed that during the whole operation process the fibrous cap of plaque at the narrowed segment remained in stable condition, the lumen stenosis rate was <40%. Cerebral perfusion imaging revealed that after the treatment the low perfusion state was markedly improved. Conclusion IVUS plays an important guiding role in performing PTA for internal carotid artery occlusion. This technique can increase the success rate of vascular recanalization and reduce the incidence of complications.
Objective To discuss the clinical value of intravascular ultrasound(IVUS) in treating internal carotid arteries occlusion. Methods The patient was diagnosed with internal carotid artery occlusion that was confirmed by CTA. Cerebral perfusion imaging showed that low perfusion area was consistent with ischemic symptoms. Guided by IVUS, percutaneous transluminal angioplasty(PTA) was performed. By using micro-catheter coaxial technology, the micro guide wire was inserted in the carotid artery until it passed through the obstructed segment; After IVUS examination proved that the micro guide wire was in the true lumen of carotid artery, angiography through micro-catheter was carried out to confirm that the distal artery was unobstructed; after adjusting the device position the embolism protector was placed. The plaque and lumen condition were assessed with IVUS, which was reevaluated after pre-expansion of balloon. After normal direction blood flow was regained, the plaque stability was assessed with IVUS virtual organization sequence.Simple balloon dilatation therapy was adopted as the fibrous cap of plaque was in stable condition and the lumen stenosis rate was <40%. Results After balloon dilatation, the obstructed artery was reopened and the blood flow regained normal direction. IVUS examination showed that during the whole operation process the fibrous cap of plaque at the narrowed segment remained in stable condition, the lumen stenosis rate was <40%. Cerebral perfusion imaging revealed that after the treatment the low perfusion state was markedly improved. Conclusion IVUS plays an important guiding role in performing PTA for internal carotid artery occlusion. This technique can increase the success rate of vascular recanalization and reduce the incidence of complications.
引文
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[12]刘波,帅杰,李志伟.慢性颈内动脉闭塞患者支架置入术联合围手术期血压控制的疗效分析[J].中华脑科疾病与康复杂志·电子版,2015,5:130-133.
[13]Reinhard M,Roth M,Guschlbauer B,et al.The course of dynamic cerebral autoregulation during cervical internal carotid artery occlusion[J].Neurol Res,2011,33:921-926.
[14]Mori M,Yamamoto H,Koga M,et al.Hyoid bone compressioninduced repetitive occlusion and recanalization of the internal carotid artery in a patient with ipsilateral brain and retinal ischemia[J].Arch Neurol,2011,68:258-259.
[15]彭应龙,宋莉,佟小强,等.颈动脉支架成形术血流动力学改变的影响因素分析[J].介入放射学杂志,2013,22:535-539.
[16]郭建明,谷涌泉,郭连瑞,等.支架成形治疗合并对侧颈动脉闭塞的重度颈动脉狭窄[J].介入放射学杂志,2015,24:10-14.
[17]Parise H,Maehara A,Stone GW,et al.Meta-analysis of randomized studies comparing intravascular ultrasound versus angiographic guidance of percutaneous coronary intervention in pre-drug-eluting stent era[J].Am J Cardiol,2011,107:374-382.
[18]李文庆,程志勇,魏明霞,等.血管内超声指导介入治疗冠状动脉分叉病变临床研究[J].介入放射学杂志,2015,24:292-295.
[2]黄清海,刘建民.慢性颈动脉闭塞血管内再通治疗评估与技术[J].中华脑血管病杂志·电子版,2012,6:343-345.
[3]闫峰,李思颉,华扬,等.血管内超声在脑血管疾病诊治中的研究进展[J].中国脑血管病杂志,2016,13:277-280.
[4]Shih CC,Lai TY,Huang CC.Evaluating the intensity of the acoustic radiation force impulse(ARFI)in intravascular ultrasound(IVUS)imaging:preliminary in vitro results[J].Ultrasonics,2016,70:64-74.
[5]Talou GD,Blanco PJ,Larrabide I,et al.Registration methods for IVUS:transversal and longitudinal transducer motion compensation[J].IEEE Trans Biomed Eng,2017,64:890-903.
[6]周虎传,宋航,刘磊.颈内动脉闭塞的研究进展[J].西南国防医药,2015,25:918-920.
[7]Lin MS,Chiu MJ,Wu YW,et al.Neurocognitive improvement after carotid artery stenting in patients with chronic internal carotid artery occlusion and cerebral ischemia[J].Stroke,2011,42:2850-2854.
[8]Turjman AS,Turjman F,Edelman ER.Role of fluid dynamics and inflammation in intracranial aneurysm formation[J].Circulation,2014,129:373-382.
[9]Krasny A,Nensa F,Sandalcioglu IE,et al.Association of aneurysms and variation of the A1 segment[J].J Neurointerv Surg,2014,6:178-183.
[10]Shaban A,Albright KC,Boehme AK,et al.Circle of Willis variants:fetal PCA[J].Stroke Res Treat,2013,2013:105937.
[11]Dolan JM,Sim FJ,Meng H,et al.Endothelial cells express a unique transcriptional profile under very high wall shear stress known to induce expansive arterial remodeling[J].Am J Physiol Cell Physiol,2012,302:C1109-C1118.
[12]刘波,帅杰,李志伟.慢性颈内动脉闭塞患者支架置入术联合围手术期血压控制的疗效分析[J].中华脑科疾病与康复杂志·电子版,2015,5:130-133.
[13]Reinhard M,Roth M,Guschlbauer B,et al.The course of dynamic cerebral autoregulation during cervical internal carotid artery occlusion[J].Neurol Res,2011,33:921-926.
[14]Mori M,Yamamoto H,Koga M,et al.Hyoid bone compressioninduced repetitive occlusion and recanalization of the internal carotid artery in a patient with ipsilateral brain and retinal ischemia[J].Arch Neurol,2011,68:258-259.
[15]彭应龙,宋莉,佟小强,等.颈动脉支架成形术血流动力学改变的影响因素分析[J].介入放射学杂志,2013,22:535-539.
[16]郭建明,谷涌泉,郭连瑞,等.支架成形治疗合并对侧颈动脉闭塞的重度颈动脉狭窄[J].介入放射学杂志,2015,24:10-14.
[17]Parise H,Maehara A,Stone GW,et al.Meta-analysis of randomized studies comparing intravascular ultrasound versus angiographic guidance of percutaneous coronary intervention in pre-drug-eluting stent era[J].Am J Cardiol,2011,107:374-382.
[18]李文庆,程志勇,魏明霞,等.血管内超声指导介入治疗冠状动脉分叉病变临床研究[J].介入放射学杂志,2015,24:292-295.