通过双功超声标准确定颈动脉支架内狭窄情况。
Determining in-stent stenosis of carotid arteries by duplex ultrasound criteria.
作者信息
Stanziale Stephen F, Wholey Mark H, Boules Tamer N, Selzer Faith, Makaroun Michel S
机构信息
Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
出版信息
J Endovasc Ther. 2005 Jun;12(3):346-53. doi: 10.1583/04-1527.1.
PURPOSE
To develop customized duplex ultrasound criteria for assessment of in-stent restenosis in the carotid arteries.
METHODS
A retrospective review was conducted of 605 patients who underwent carotid artery stenting (CAS) from July 1996 to August 2004 at a single institution. Data on the stented carotid artery were accumulated from patients who had carotid angiography and duplex ultrasound (US) within 30 days of each other. Preliminary review found 118 pairs of ultrasound scans and angiograms in stented carotid arteries. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and internal carotid artery to common carotid artery ratio (ICA/CCA) were examined. Angiographic stenosis was graded by NASCET criteria and compared to velocity parameters at clinically relevant levels of stenosis. The Student t test was used to compare similarly obtained data from 41 nonstented carotid arteries.
RESULTS
PSV, ICA/CCA ratio, and EDV increased to a greater degree in stented arteries with stenosis. In 50% to 69% stenotic arteries, mean ICA/CCA ratio was 4.74+/-0.61 in stented versus 3.68+/-0.24 in nonstented carotid arteries (p = 0.043). In arteries with > or = 70% stenosis, there were increases in PSV (475+/-22 versus 337+/-26 cm/s, p = 0.001), EDV (172+/-23 versus 122+/-8 cm/s, p = 0.043), and the ICA/CCA ratio (8.18+/-2.19 versus 5.11+/-0.66, p = 0.063) in stented versus nonstented arteries, respectively. To detect > or = 70% angiographic stenosis, PSV > or = 350 cm/s had 100% sensitivity, 96% specificity, 55% positive predictive value (PPV), and 100% negative predictive value (NPV); an ICA/CCA ratio > or = 4.75 had 100% sensitivity, 95% specificity, 50% PPV, and 100% NPV. To predict > 50% stenosis, combining PSV > or = 225 cm/s and ICA/PCA ratio > or = 2.5 increased sensitivity (95%), specificity (99%), PPV (95%), NPV (99%), and accuracy (98%).
CONCLUSIONS
PSV and ICA/CCA increase with stenosis to a greater extent in stented carotid arteries, necessitating revision of existing US criteria to follow CAS patients. To determine > or = 70% in-stent stenosis, PSV > or = 350 cm/s and ICA/CCA ratio > or = 4.75 are sensitive criteria. To determine > or = 50% stenosis, combining PSV > or = 225 cm/s and ICA/PCA ratio > or = 2.5 is optimal.
目的
制定用于评估颈动脉支架内再狭窄的定制双功超声标准。
方法
对1996年7月至2004年8月在单一机构接受颈动脉支架置入术（CAS）的605例患者进行回顾性研究。收集在彼此30天内进行颈动脉血管造影和双功超声（US）检查的患者的支架置入颈动脉的数据。初步审查发现了118对支架置入颈动脉的超声扫描和血管造影图像。检查了收缩期峰值速度（PSV）、舒张末期速度（EDV）以及颈内动脉与颈总动脉比值（ICA/CCA）。血管造影狭窄程度按照北美症状性颈动脉内膜切除术试验（NASCET）标准分级，并与临床相关狭窄水平的速度参数进行比较。采用Student t检验比较来自41条未置入支架的颈动脉的类似数据。
结果
狭窄的支架置入动脉中，PSV、ICA/CCA比值和EDV升高幅度更大。在50%至69%狭窄的动脉中，支架置入颈动脉的平均ICA/CCA比值为4.74±0.61，而未置入支架的颈动脉为3.68±0.24（p = 0.043）。在狭窄≥70%的动脉中，支架置入动脉的PSV（475±22 vs 337±26 cm/s，p = 0.001）、EDV（172±23 vs 122±8 cm/s，p = 0.043）和ICA/CCA比值（8.18±2.19 vs 5.11±0.66，p = 0.063）均升高。为检测血管造影狭窄≥70%，PSV≥350 cm/s的敏感度为100%、特异度为96%、阳性预测值（PPV）为55%、阴性预测值（NPV）为100%；ICA/CCA比值≥4.75的敏感度为100%、特异度为95%、PPV为50%、NPV为100%。为预测狭窄>50%，联合PSV≥225 cm/s和ICA/PCA比值≥2.5可提高敏感度（95%）、特异度（99%）、PPV（95%）、NPV（99%）和准确度（98%）。
结论
在支架置入的颈动脉中，PSV和ICA/CCA随狭窄程度升高幅度更大，因此需要修订现有超声标准以随访CAS患者。为确定支架内狭窄≥70%时，PSV≥350 cm/s和ICA/CCA比值≥4.75是敏感标准。为确定狭窄≥50%时，联合PSV≥225 cm/s和ICA/PCA比值≥2.5是最佳选择。
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