颈动脉支架置入前后脑灌注的半球间不对称性：一项99mTc-HMPAO单光子发射计算机断层扫描研究

Interhemispheric asymmetry in brain perfusion before and after carotid stenting: a 99mTc-HMPAO SPECT study.

作者信息

Sfyroeras Giorgos S, Arsos Georgios, Karkos Christos D, Liasidis Charalampos, Spyridis Charalampos, Boundas Dimitrios, Dimitriadis Athanasios S, Gerassimidis Thomas S

机构信息

5th Surgical Clinic, Medical School, Aristotle University of Thessaloniki, Hippocratio Hospital, Konstantinoupoleos 49, Thessaloniki 546 42, Greece.

出版信息

J Endovasc Ther. 2006 Dec;13(6):729-37. doi: 10.1583/06-1857.1.

DOI:10.1583/06-1857.1

PMID:17154707

Abstract

PURPOSE

To assess the effect of unilateral carotid angioplasty and stenting (CAS) on cerebral perfusion asymmetry in patients with severe extracranial carotid stenosis by means of technetium Tc 99m hexamethyl-propyleneamine oxime brain single photon emission computed tomography ((99m)Tc-HMPAO SPECT).

METHODS

Twenty-nine consecutive patients (22 men; median age 68 years, range 58-80; 13 symptomatic) undergoing unilateral CAS were included in the study. Brain perfusion was assessed by (99m)Tc-HMPAO brain SPECT prior to the procedure and postoperatively at 8 hours and at 2 to 4 months. The asymmetry index (AI), a measure of the interhemispheric asymmetry in perfusion, was calculated as [(counts in "healthy" hemisphere-counts in hemisphere with carotid stenosis)/counts in "healthy" hemisphere]x100.

RESULTS

The preoperative AI demonstrated a wide variation (mean -0.5%+/-8.4%, range -19.5% to 14.1%). There was no significant correlation between the degree of carotid stenosis and preoperative AI. The mean preoperative AI in the asymptomatic patients was lower than in the symptomatic group [-4.0%+/-8.5% (range -19.5% to 8.2%) versus 3.8%+/-6.4% (range -5.2% to 14.1%), p=0.01], suggesting reduced perfusion of the ipsilateral cerebral hemisphere compared to the contralateral side in symptomatic patients. AI variation did not improve after CAS; there was no difference in AI among the 3 SPECT studies (p=0.75). Preoperative AI correlated significantly with late AI (r=0.74, p<0.0001); however, there was no statistically significant correlation between immediate postoperative AI and either preoperative (r=0.24, p=0.217) or late (r=0.24, p=0.249) AI.

CONCLUSION

Asymmetry in cerebral perfusion in patients with severe extracranial carotid atherosclerosis does not correlate with the degree of carotid stenosis. Symptomatic patients demonstrate compromised perfusion of the ipsilateral hemisphere compared to asymptomatic patients. As judged by (99m)Tc-HMPAO SPECT scanning, cerebral perfusion patterns do not significantly change after CAS.

摘要

目的

通过锝 Tc 99m 六甲基丙烯胺肟脑单光子发射计算机断层扫描（(99m)Tc-HMPAO SPECT）评估单侧颈动脉血管成形术和支架置入术（CAS）对严重颅外颈动脉狭窄患者脑灌注不对称性的影响。

方法

本研究纳入了 29 例连续接受单侧 CAS 的患者（22 例男性；中位年龄 68 岁，范围 58 - 80 岁；13 例有症状）。在手术前、术后 8 小时以及术后 2 至 4 个月通过(99m)Tc-HMPAO 脑 SPECT 评估脑灌注。不对称指数（AI）用于衡量半球间灌注的不对称性，计算方法为[(“健康”半球计数 - 有颈动脉狭窄半球计数)/“健康”半球计数]×100。

结果

术前 AI 差异较大（平均 -0.5%±8.4%，范围 -19.5%至 14.1%）。颈动脉狭窄程度与术前 AI 之间无显著相关性。无症状患者的术前平均 AI 低于有症状组[-4.0%±8.5%（范围 -19.5%至 8.2%）对 3.8%±6.4%（范围 -5.2%至 14.1%），p = 0.01]，提示有症状患者患侧大脑半球的灌注相对于对侧有所减少。CAS 后 AI 变化未改善；3 次 SPECT 研究的 AI 无差异（p = 0.75）。术前 AI 与晚期 AI 显著相关（r = 0.74，p < 0.0001）；然而，术后即刻 AI 与术前（r = 0.24，p = 0.217）或晚期（r = 0.24，p = 0.249）AI 之间无统计学显著相关性。