经口超声评估颈动脉血流对预测颈动脉内膜切除术后脑血流动力学的作用

Transoral ultrasonographic evaluation of carotid flow in predicting cerebral hemodynamics after carotid endarterectomy.

作者信息

Kamouchi M, Kishikawa K, Okada Y, Inoue T, Toyoda K, Ibayashi S, Iida M

机构信息

Department of Cerebrovascular Disease, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.

出版信息

AJNR Am J Neuroradiol. 2006 Jun-Jul;27(6):1295-9.

PMID:16775283

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8133943/

Abstract

PURPOSE

We investigated whether measurement of blood flow in the extracranial distal internal carotid artery (ICA) by transoral carotid ultrasonography (TOCU) can predict the cerebral hemodynamics and the hemodynamic effect of carotid endarterectomy (CEA) in patients with unilateral carotid stenosis.

METHODS

Forty-nine patients with unilateral ICA stenosis who underwent CEA were studied. Preoperative blood flow in the poststenotic portion of the extracranial ICA was studied by using TOCU. Regional cerebral blood flow (rCBF) and vasoreactivity to acetazolamide (VR) in the territory of the middle cerebral artery were investigated by using single-photon emission CT (SPECT) before, 2 weeks after, and 3 months after CEA.

RESULTS

Doppler flow velocities in the extracranial distal ICA measured transorally by TOCU correlated with baseline as well as postacetazolamide rCBF in the ipsilateral side (regression analysis, P < .05). Diameter and blood flow volume in the extracranial distal ICA were associated with ipsilateral postacetazolamide rCBF and VR (regression analysis, P < .05). When the patients were divided into 2 groups according to the ICA volume flow distal to a carotid stenosis, group I < 3.5 mL/s and group II > 3.5 mL/s, ipsilateral postacetazolamide rCBF in group I was significantly lower than that in group II (P = .008). Ipsilateral postacetazolamide rCBF (analysis of variance [ANOVA], P = .02) and VR (ANOVA, P = .03) significantly improved after CEA for 3 months in group I but not in group II.

CONCLUSION

TOCU can detect the decrease in poststenotic flow of the distal extracranial ICA that is indicative of impaired intracranial hemodynamics and predictive for improvement of cerebral blood flow after CEA in patients with unilateral carotid stenosis.

摘要

目的

我们研究了经口颈动脉超声检查（TOCU）测量颅外颈内动脉（ICA）远端血流是否能够预测单侧颈动脉狭窄患者的脑血流动力学以及颈动脉内膜切除术（CEA）的血流动力学效果。

方法

对49例行CEA的单侧ICA狭窄患者进行研究。使用TOCU研究颅外ICA狭窄后段的术前血流。在CEA术前、术后2周和术后3个月，使用单光子发射计算机断层扫描（SPECT）研究大脑中动脉区域的局部脑血流量（rCBF）和对乙酰唑胺的血管反应性（VR）。

结果

通过TOCU经口测量的颅外ICA远端多普勒血流速度与同侧的基线以及乙酰唑胺激发后的rCBF相关（回归分析，P <.05）。颅外ICA远端的直径和血流量与同侧乙酰唑胺激发后的rCBF和VR相关（回归分析，P <.05）。根据颈动脉狭窄远端的ICA体积流量将患者分为两组，I组<3.5 mL/s，II组>3.5 mL/s，I组同侧乙酰唑胺激发后的rCBF显著低于II组（P =.008）。I组在CEA术后3个月时同侧乙酰唑胺激发后的rCBF（方差分析[ANOVA]，P =.02）和VR（ANOVA，P =.03）显著改善，而II组未改善。