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中华医学超声杂志(电子版) ›› 2020, Vol. 17 ›› Issue (07) : 679 -683. doi: 10.3877/cma.j.issn.1672-6448.2020.07.017

所属专题: 文献

外周血管超声影像学

血管超声评价颈动脉蹼的结构特征
杨洁1, 华扬1,(), 周福波1, 田晓洁1, 刘然1, 贾凌云1   
  1. 1. 100053 北京,首都医科大学宣武医院血管超声科
  • 收稿日期:2020-05-18 出版日期:2020-07-01
  • 通信作者: 华扬

Ultrasonographic features of carotid web

Jie Yang1, Yang Hua1,(), Fubo Zhou1, Xiaojie Tian1, Ran Liu1, Lingyun Jia1   

  1. 1. Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
  • Received:2020-05-18 Published:2020-07-01
  • Corresponding author: Yang Hua
  • About author:
    Corresponding author: Hua Yang, Email:
引用本文:

杨洁, 华扬, 周福波, 田晓洁, 刘然, 贾凌云. 血管超声评价颈动脉蹼的结构特征[J/OL]. 中华医学超声杂志(电子版), 2020, 17(07): 679-683.

Jie Yang, Yang Hua, Fubo Zhou, Xiaojie Tian, Ran Liu, Lingyun Jia. Ultrasonographic features of carotid web[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(07): 679-683.

目的

通过血管超声评估颈动脉蹼(CW)的结构特征。

方法

连续纳入2018年1月至2019年6月于首都医科大学宣武医院就诊的经超声检查并经CT血管造影(CTA)证实的CW患者共66例。根据超声对狭窄程度的判定,将患者分为颈动脉<50%狭窄组54例,≥50%狭窄组12例。应用超声测量CW的长度、厚度、与管壁间锐性夹角,记录CW上端的血流方向特征(顺向或逆向血流)、CW与管壁间血栓形成情况,比较2组间CW结构特征的差异,并分析不同颈动脉狭窄程度对缺血性脑卒中发生的影响。

结果

首次诊断为CW的患者为42例(42/66,63.6%),余24例患者首次检查分别诊断为溃疡斑块21例(21/66,31.8%)和夹层3例(3/66,4.5%)。<50%狭窄组与≥50%狭窄组CW的长度、厚度、方向、周边血栓情况差异均无统计学意义(P均>0.05)。<50%狭窄组CW与管壁间夹角显著小于≥50%狭窄组(中位数:39o vs 73o,P=0.002),而<50%狭窄组中夹角≤60o的发生率也显著高于≥50%狭窄组(74.1% vs 41.7%,P=0.042)。<50%狭窄组CW处的颈动脉残余内径明显大于≥50%狭窄组,而收缩期峰值流速明显低于≥50%狭窄组,2组比较,差异均有统计学意义(P均<0.001)。缺血性脑卒中患者与非卒中患者的颈动脉狭窄程度差异无统计学意义(P=0.321)。

结论

超声通过二维及彩色多普勒模式可评估CW的结构特征,CW与管壁间夹角较大时更易导致局部血管狭窄≥50%,但血管狭窄并非导致CW患者脑卒中的重要原因。

Objective

To evaluate the features of carotid web (CW) by ultrasonography.

Methods

A total of 66 patients with CW were retrospectively enrolled from January 2018 to June 2019 at Xuanwu Hospital, Capital Medical University. All patients were examined by both ultrasonography and CTA, and were divided into either a<50% stenosis group (54 cases) or a ≥50% stenosis group (12 cases). The ultrasonographic characteristics of CW, including the length, thickness, direction (forward or backward to the flow), acute angle between the web and carotid wall, and thrombus between the web and carotid wall were compared between the two groups. The stenosis degrees of carotid artery were compared between patients with and without ischemic stroke.

Results

Forty-two (42/66, 63.6%) patients were diagnosed with CW by initial CDFI examination, of whom 21 (21/66, 31.8%) were diagnosed with ulcerative plaque and 3 (3/66, 4.5%) were diagnosed with carotid dissection at first but confirmed by second examination. There were no differences in the web length, thickness, direction, or thrombus detected between the two groups (P>0.05). The angle between the web and carotid wall in the<50% stenosis group was significantly smaller than that of the ≥50% stenosis group (median angel 39o vs 73o, P=0.002), and the percentage of patients with an angle≤ 60o in the<50% stenosis group was significantly higher than that of the ≥50% stenosis group (74.1% vs 41.7%, P=0.042). The diameter of the residual carotid artery at CW location in the<50% stenosis group was significantly larger and peak systolic velocity was significantly higher in the<50% stenosis group than in the≥50% stenosis group (P<0.001). The stenosis degrees of carotid artery were not statistically different between patients with and without ischemic stroke (P=0.321).

Conclusion

Ultrasonography can be used to evaluate the characteristics of carotid web in 2D and color mode. When the angle between the CW and carotid wall is large, the carotid artery stenosis ≥ 50% is more likely to happen, but carotid artery stenosis is not the main cause of ischemic stroke.

表1 不同程度颈动脉狭窄组的一般资料及动脉硬化危险因素比较
图1 女性,50岁,反复发作言语不利,诊断脑梗死。图a为二维超声显示颈动脉球部后壁顺血流方向的凸向管腔的等回声双边征(膜状结构),与血管壁间呈30o夹角(白色箭头所示);图b为彩色多普勒血流显示颈动脉蹼与管壁夹角内涡流形成(白色箭头所示),首次超声检查诊断为溃疡斑块;图c为手术病理显示颈动脉蹼为内膜肌纤维增生和黏液样变性;图d,e分别为CTA颈动脉球部轴状位及矢状位显示薄膜样充盈缺损(黄色箭头所示)
表2 不同程度颈动脉狭窄组的颈动脉蹼超声结构特征比较
1
Wirth FP, Miller WA, Russell AP. Atypical fibromuscular hyperplasia. Report of two cases [J]. J Neurosurg, 1981, 54(5): 685-689.
2
Connett MC, Lansche JM. Fibromuscular hyperplasia of the internal carotid artery: report of a case [J]. Ann Surg, 1965, 162(1): 59-62.
3
Coutinho JM, Derkatch S, Potvin AR, et al. Carotid artery web and ischemic stroke: A case-control study [J]. Neurology, 2017, 88(1): 65-69.
4
Choi PM, Singh D, Trivedi A, et al. Carotid webs and recurrent ischemic strokes in the era of CT angiography [J]. AJNR Am J Neuroradiol, 2015, 36(11): 2134-2139.
5
Joux J, Chausson N, Jeannin S, et al. Carotid-bulb atypical fibromuscular dysplasia in young Afro-Caribbean patients with stroke [J]. Stroke, 2014, 45(12): 3711-3713.
6
Moneta GL, Edwards JM, Chitwood RW, et al. Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning [J]. J Vasc Surg, 1993, 17(1): 152-157.
7
华扬,刘蓓蓓,凌晨, 等. 超声检查对颈动脉狭窄50%~69%和70~99%诊断准确性的评估[J].中国脑血管病杂志, 2006, 3(5): 211-218.
8
Kliewer MA, Carroll BA. Ultrasound case of the day: internal carotid artery web (atypical fibromuscular dysplasia) [J]. Radiographics, 1991, 11(3): 504-505.
9
Compagne KCJ, van Es ACGM, Berkhemer OA, et al. Prevalence of Carotid Web in Patients with Acute Intracranial Stroke Due to Intracranial Large Vessel Occlusion [J]. Radiology, 2018, 286(3): 1000-1007.
10
Zhang AJ, Dhruv P, Choi P, et al. A Systematic Literature Review of Patients with Carotid Web and Acute Ischemic Stroke [J]. Stroke, 2018, 49(12): 2872-2876.
11
Sajedi PI, Gonzalez JN, Cronin CA, et al. Carotid bulb webs as a cause of "cryptogenic" ischemic stroke [J]. AJNR Am J Neuroradiol, 2017, 38(7): 1399-1404.
12
Fu W, Crockett A, Low G, et al. Internal carotid artery web: Doppler ultrasound with CT angiography correlation [J]. J Radiol Case Rep, 2015, 9(5): 1-6.
13
Kim SJ, Nogueira RG, Haussen DC. Current Understanding and Gaps in Research of Carotid Webs in Ischemic Strokes: A Review [J]. JAMA Neurol, 2019, 76(3): 355-361.
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