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中华医学超声杂志(电子版) ›› 2018, Vol. 15 ›› Issue (09) : 667 -672. doi: 10.3877/cma.j.issn.1672-6448.2018.09.006

所属专题: 文献

外周血管超声影像学

血管超声评估颈内动脉闭塞血运重建复合手术的成功性
周瑛华1, 华扬1,(), 王力力1, 夏明钰1, 段春1, 凌晨1   
  1. 1. 100053 北京,首都医科大学宣武医院血管超声诊断科
  • 收稿日期:2018-07-05 出版日期:2018-09-01
  • 通信作者: 华扬
  • 基金资助:
    首都卫生发展科研专项(首发2018-2-2011)

Evaluation of the successful revascularization for internal carotid artery occlusion by vascular ultrasound

Yinghua Zhou1, Yang Hua1,(), Lili Wang1, Mingyu Xia1, Chun Duan1, Chen Ling1   

  1. 1. Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
  • Received:2018-07-05 Published:2018-09-01
  • Corresponding author: Yang Hua
  • About author:
    Corresponding author: Hua Yang, Email:
引用本文:

周瑛华, 华扬, 王力力, 夏明钰, 段春, 凌晨. 血管超声评估颈内动脉闭塞血运重建复合手术的成功性[J/OL]. 中华医学超声杂志(电子版), 2018, 15(09): 667-672.

Yinghua Zhou, Yang Hua, Lili Wang, Mingyu Xia, Chun Duan, Chen Ling. Evaluation of the successful revascularization for internal carotid artery occlusion by vascular ultrasound[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(09): 667-672.

目的

应用颈动脉彩色多普勒血流成像(CDFI)和经颅彩色多普勒超声(TCCS)评估颈内动脉闭塞患者行颈动脉内膜切除术(CEA)并取栓和(或)支架植入复合术的血运重建再通的成功性。

方法

回顾性连续纳入2007年1月至2018年1月在首都医科大学宣武医院经(DSA)确诊为颈内动脉闭塞,并接受复合手术治疗的患者78例。术前1周和术后1周内行CDFI和TCCS检查。分析比较术前颈内动脉近段及远段内径、闭塞管腔内病变回声、责任斑块长度、交通支开放(眼动脉血流方向逆转)与否等因素对复合手术血运重建再通成功性的影响。

结果

78例患者复合手术再通成功率为78.2%(61/78)。围手术期并发症的发生率为6.4%。多因素Logistic回归分析结果显示,闭塞管腔内均质回声、眼动脉血流方向逆转均是颈内动脉闭塞再通成功性的独立影响因素(OR=0.069,95%CI:0.045~0.604,P=0.007;OR=0.164,95%CI:0.009~0.501,P=0.008)。

结论

闭塞管腔内的回声性质、眼动脉方向的逆转与颈内动脉闭塞后血运重建的再通率密切相关。CDFI与TCCS联合评估颈内动脉闭塞复合手术的成功性具有重要的价值。

Objective

To evaluate the successful revascularization in patients with internal carotid artery occlusion (ICAO) after carotid endarterectomy (CEA), arterial embolectomy (CEA & AEmb) or CEA and stent implantation (CEA & Stent) using color doppler flow imaging (CDFI) and transcranial color-coded sonography (TCCS).

Methods

From January 2007 to January 2018, a total of 78 patients with ICAO confirmed by DSA and treated with CEA & AEmb or CEA & Stent were included in this study. CDFI and TCCS were completed in a week before and after surgery. The influence factor for success of recanalization were recorded and analyzed, such as diameters proximal and distal to the internal carotid artery (ICA), echo characteristics in the lumen of ICA, length of the plaque and thrombus, collateral circulation established (The blood flow of the ophthalmic artery reversed).

Results

The rate of complete recanalization was 78.2% (61/78), while 17 patients were failed (15 had occlusion and 2 had severe residual stenosis). The incidence of perioperative complications was 6.4%. Multiple logistic regression analysis showed that homogeneous echo intra-ICA (OR=0.069, 95%CI: 0.045~0.604, P=0.007) and flow reversal of the ophthalmic artery (OR=0.164, 95%CI: 0.009~0.501, P=0.008) were independent influence factors for recanalization rate. There was no significant difference in the effect on the rate of recanalization between the proximal and distal to ICA diameter (P=0.078).

Conclusions

The echogenicity intra lumen of ICAO and the reversed direction of the ophthalmic artery are closely related to the rate of recanalization. It is of the great predictive value to evaluate the success of ICAO combined CDFI with TCCS.

图1~6 患者,男性,56岁,因"左肢无力20 d"收住入院,经数字减影血管造影及血管超声证实右侧颈内动脉闭塞,行复合手术(颈动脉内膜切除术+支架)。图1为数字减影血管造影示右侧颈内动脉闭塞;图2为颈动脉超声示右侧颈内动脉近段可见等回声为主的不均回声斑块(伴钙化),颈内动脉中远端管腔内充填均质低回声;图3为彩色多普勒血流成像示右侧颈内动脉管腔内未探及血流信号;图4为右侧颈内动脉行复合手术后数字减影血管造影显影良好;图5为颈动脉超声示右侧颈内动脉中远端可见支架回声,管腔恢复通畅;图6为彩色多普勒血流成像示右侧颈内动脉血流通畅
表1 再通成功组与再通未成功组患者复合手术成功性影响因素比较
表2 颈内动脉闭塞患者复合手术成功性影响因素的多因素Logistic回归分析结果
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