Iwai Ryosei, Tsumura Kohtaro, Kuwayama Naoya, Hirashima Yutaka, Endo Shunro
Department of Neurosurgery, Neurovascular Center, Sekishinkai Kawasaki Saiwai Hospital, 39-1 Miyakocho, Saiwai-ku, Kawasaki 212-0021, Japan.
No To Shinkei. 2003 Aug;55(8):661-7.
We have performed rotational DSA for internal carotid artetry (ICA) stenosis and examined cross sectional imaging of the stenosis. Then, we compared the area stenosis rate (ASR) with stenosis rate by NASCET method and with results of duplex carotid ultrasonography. Of consecutive 451 patients who underwent digital subtraction angiography, 28 patients with ICA stenosis were selected for this study. Imaging data were transmitted to a workstation, and three-dimension (3-D) images were prepared, and cross sectional images of the highest-grade stenotic portion were obtained. ASRs were calculated [1-(the area of highest stenotic portion of ICA/the area of distal ICA)] x 100, which were compared with stenosis rates by NASCET method, as well as peak systolic velocity ratios (PSVR) of ICA to common carotid artery (CCA) determined by duplex carotid ultrasonography (USG). Cross sectional images in all patients were made except for restless patients, thereby morphology of the stenosis was feasible and measurements of cross section and diameter were possible. ASR and stenosis rate by NASCET method showed a very high correlation, and ASR was obtained by formula of (12.886 + 1.037 x stenosis rate by NASCET method). In patients with distorted stenosis, the stenosis rate was overestimated by NASECT method. ICA/CCA PSVR could predict stenosis to some extent, and in particular, all the patients with ICA/CCA PSVR of 3.1 or greater were found to have high grade stenosis. However duplex carotid USG failed to detect stenosis in a patient with high-grade stenosis at high position. In conclusion, as to ICA stenosis, 3-D image could show the stenosis precisely, and was considered to be useful as a routine examination.
我们对颈内动脉（ICA）狭窄进行了旋转数字减影血管造影（DSA），并检查了狭窄的横断面成像。然后，我们将面积狭窄率（ASR）与采用北美症状性颈动脉内膜切除术（NASCET）方法得出的狭窄率以及颈动脉双功超声检查结果进行了比较。在连续451例行数字减影血管造影的患者中，选择了28例患有ICA狭窄的患者进行本研究。成像数据被传输到工作站，制备三维（3-D）图像，并获取最高级狭窄部位的横断面图像。计算ASR [1 - （ICA最高级狭窄部位的面积/ICA远端的面积）]×100，并将其与NASCET方法得出的狭窄率以及通过颈动脉双功超声检查（USG）确定的ICA与颈总动脉（CCA）的收缩期峰值速度比（PSVR）进行比较。除了躁动不安的患者外，对所有患者都进行了横断面成像，从而可以了解狭窄的形态，并且能够进行横断面和直径的测量。ASR与NASCET方法得出的狭窄率显示出非常高的相关性，并且ASR可通过公式（12.886 + 1.037×NASCET方法得出的狭窄率）获得。在狭窄扭曲的患者中，NASCET方法高估了狭窄率。ICA/CCA PSVR在一定程度上可以预测狭窄，特别是发现所有ICA/CCA PSVR为3.1或更高的患者都患有高级别狭窄。然而，颈动脉双功超声检查未能检测出一名高位高级别狭窄患者的狭窄情况。总之，对于ICA狭窄，三维图像可以精确显示狭窄情况，被认为作为常规检查很有用。
