颈动脉支架置入术对脑梗死患者脑血流动力学变化的随访观察及与临床预后的相关性分析
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摘要
目的随访观察颈动脉狭窄脑梗死患者支架置入术后的颅内血流动力学及脑血管反应性(cer-ebral vascular reactivity,CVR)的变化,比较介入治疗对颈动脉狭窄患者临床预后的影响。方法选取本院收治的103例颈动脉狭窄的脑梗死患者,根据患者及家属的治疗意愿分为手术组50例和药物组53例;手术组均接受颈动脉支架置入术(carotid artery stenting,CAS)及药物的治疗,药物组仅接受药物治疗,记录2组的NIHSS评分变化、脑卒中和死亡事件;所有手术患者均在术前、术后3d、1、3、6、12个月进行CDFI和TCD检查,测量颈动脉狭窄局部管径、狭窄段收缩期峰值流速(peak systolic velocity,PSV)、阻力指数(resistance in-dex,RI)及同侧大脑中动脉(MCA)的PSV、搏动指数(pulsatilityt index,PI)及CVR,比较手术前后的血流动力学变化。结果 2组NIHSS评分变化均呈下降趋势(P<0.05),术后3、6、12个月手术组NIHSS评分明显低于药物组(P<0.05);术后颈动脉原狭窄处内径明显增宽,PSV及RI低于术前,患侧大脑中动脉PSV、PI及CVR高于术前(P均<0.05);手术组手术前后的CVR与美国国立卫生研究院卒中量表评分呈负相关(r=-0.84,-0.75,-0.66,-0.78,-0.61,P<0.05)。结论 CAS治疗后颈动脉狭窄患者颈部血管结构及血流动力学明显改善,可有效改善脑梗死患者的中远期预后,且术后CVR的改变可用于预测CAS治疗后的中远期疗效。
Objective To follow-up of the changes of cervical vessel,intracranial hemodynamics and cerebral vascular reactivity(CVR)of the patients after carotid artery stent implantation.To compare the effect of interventional therapy on the prognosis of patients with cerebral infarction with carotid stenosis.Methods 103 patients with carotid stenosis were selected and then divided into 50 cases of surgery group and 53 cases of drug group according to the willingness of patients and their families.The surgical group received carotid stenting(CAS)and drug therapy.The drug group only received drug treatment.The NIHSS scores,stroke and death were recorded in both groups.surgical group were examined by CDFI and TCD at the preoperative,postoperative 3 th day,1 th,3 th,6 th,12 th month.The local diameter of stenosis carotid artery,peak systolic velocity(PSV)and resistance index(RI)were measured.The PSV,pulsatility index(PI)and CVR of the ipsilateral middle cerebral artery(MCA).Hemodynamic changes were compared before and after treatment.Results The NIHSS scores in both groups showed a decreasing trend(P<0.05).The NIHSS scores at the 3 rd,6 th,and 12 th month were significantly lower in the surgery group than those in the drug group,and the difference was statistically significant(P<0.05).After the carotid artery stenting the internal diameter was significantly wider,PSV and RI were lower than those at the preoperative.The PSV,PI and CVR of affected middle cerebral artery were higher than those at the preoperative(P<0.05).The CVR before and after stenting was negatively correlated with the NIH Stroke Scale score(r=-0.84,-0.75,-0.66,-0.78,-0.61,P<0.05).Conclusion The vascular structure and cerebral hemodynamics of the patients with carotid artery stenosis in the surgical group were significantly improved.The NIHSS score was significantly lower than that in drug therapy group alone.Therefore,CAS could effectively improve the prognosis of patients with cerebral infarction.Changes in CVR could be used to predict the long-term efficacy after CAS treatment.
Objective To follow-up of the changes of cervical vessel,intracranial hemodynamics and cerebral vascular reactivity(CVR)of the patients after carotid artery stent implantation.To compare the effect of interventional therapy on the prognosis of patients with cerebral infarction with carotid stenosis.Methods 103 patients with carotid stenosis were selected and then divided into 50 cases of surgery group and 53 cases of drug group according to the willingness of patients and their families.The surgical group received carotid stenting(CAS)and drug therapy.The drug group only received drug treatment.The NIHSS scores,stroke and death were recorded in both groups.surgical group were examined by CDFI and TCD at the preoperative,postoperative 3 th day,1 th,3 th,6 th,12 th month.The local diameter of stenosis carotid artery,peak systolic velocity(PSV)and resistance index(RI)were measured.The PSV,pulsatility index(PI)and CVR of the ipsilateral middle cerebral artery(MCA).Hemodynamic changes were compared before and after treatment.Results The NIHSS scores in both groups showed a decreasing trend(P<0.05).The NIHSS scores at the 3 rd,6 th,and 12 th month were significantly lower in the surgery group than those in the drug group,and the difference was statistically significant(P<0.05).After the carotid artery stenting the internal diameter was significantly wider,PSV and RI were lower than those at the preoperative.The PSV,PI and CVR of affected middle cerebral artery were higher than those at the preoperative(P<0.05).The CVR before and after stenting was negatively correlated with the NIH Stroke Scale score(r=-0.84,-0.75,-0.66,-0.78,-0.61,P<0.05).Conclusion The vascular structure and cerebral hemodynamics of the patients with carotid artery stenosis in the surgical group were significantly improved.The NIHSS score was significantly lower than that in drug therapy group alone.Therefore,CAS could effectively improve the prognosis of patients with cerebral infarction.Changes in CVR could be used to predict the long-term efficacy after CAS treatment.
引文
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[8]戴旭辉,梅芳,余晓梅.颈动脉狭窄患者支架置入前后脑血流动力学变化[J].实用医学杂志,2015,31(8):1275-1277.
[9]Huang H,Chen K,Guo T,et al.Treatment with carotid angioplasty stent placement for post-stroke depression compared to antidepressants[J].Neurosciences(Riyadh),2012,17(1):53-56.
[10]姜海波,曹辉.介入治疗对脑梗死伴重度颈动脉狭窄患者近期预后的影响[J].中国实用神经疾病杂志,2015,18(16):51-52.
[11]Younis GA,Gupta K,Mortazavi A,et al.Predictors of carotid stent restenosis[J].Catheter Cardiovasc Interv,2007,69(5):673-682.
[12]王洪科,张小宁,刘培琴,等.颈动脉超声和经颅多普勒超声联合评价颈动脉狭窄支架治疗的临床价值[J].中国神经精神疾病杂志,2014,40(1):31-34.
[13]戴旭辉,余晓梅,苏曼莉,等.颈部彩超联合TCD对颈动脉支架置入的随访观察[J].医疗卫生装备,2017,382(2):86-88.
[2]中华医学会神经病学分会脑血管病学组、急性缺血性脑卒中诊治指南撰写组、中国急性缺血性脑卒中诊治指南2010[J].中华医学信息报,2010,25(14):16-19.
[3]North American Symptomatic Carotid Endarterectomy Tria1.Methods,patient characteristics,and progress[J].Stroke,1991,22(6):720.
[4]Barry RD,Vogt T,Philip HF,et al.Risk factors for stroke and type of stroke in persons with isolated systolic hypertension[J].Stroke,1998,29(71):1333-1340.
[5]Ouhlous M,Flach HZ,De Weert TT,et al.Carotid plaque composition and cerebral infarction:Mr imaging study[J].American Journal of Neuroradiology,2005,26(5):1044-1049.
[6]Sztajzel R.Ultrasonographic assessment of the morphological characteristics of the carotid plaque[J].Swiss Med Wkly,2005,135(43/44):635-643.
[7]朱慧敏,翟登月,殷勤,等.颈动脉支架置人术后颅内血管反应性动态观察[J].中华神经医学杂志,2011,10(1):66.
[8]戴旭辉,梅芳,余晓梅.颈动脉狭窄患者支架置入前后脑血流动力学变化[J].实用医学杂志,2015,31(8):1275-1277.
[9]Huang H,Chen K,Guo T,et al.Treatment with carotid angioplasty stent placement for post-stroke depression compared to antidepressants[J].Neurosciences(Riyadh),2012,17(1):53-56.
[10]姜海波,曹辉.介入治疗对脑梗死伴重度颈动脉狭窄患者近期预后的影响[J].中国实用神经疾病杂志,2015,18(16):51-52.
[11]Younis GA,Gupta K,Mortazavi A,et al.Predictors of carotid stent restenosis[J].Catheter Cardiovasc Interv,2007,69(5):673-682.
[12]王洪科,张小宁,刘培琴,等.颈动脉超声和经颅多普勒超声联合评价颈动脉狭窄支架治疗的临床价值[J].中国神经精神疾病杂志,2014,40(1):31-34.
[13]戴旭辉,余晓梅,苏曼莉,等.颈部彩超联合TCD对颈动脉支架置入的随访观察[J].医疗卫生装备,2017,382(2):86-88.