解读颈动脉支架介入术中 TCD 频谱形态。
Interpretation of TCD spectral patterns detected during carotid artery stent interventions.
机构信息
Department of Neurology, Chungnam National University Hospital and College of Medicine, Daejeon, South Korea.
出版信息
J Endovasc Ther. 2011 Aug;18(4):518-26. doi: 10.1583/11-3400.1.
PURPOSE
To classify transcranial Doppler (TCD) spectral patterns and analyze the significance of the patterns in the determination of hemodynamic alterations occurring during filter-protected carotid artery stent (CAS) procedures.
METHODS
Data on middle cerebral artery (MCA) monitoring and post-CAS diffusion weighted magnetic resonance imaging (DWMRI) were reviewed for 53 patients (45 men; mean age 67.6 ± 8.3 years) who underwent TCD evaluation before CAS and TCD monitoring during the procedure. TCD spectral patterns were classified according to the hemodynamic changes that occurred after different portions of the CAS procedures. The relationships among the spectral patterns and the frequency and location of new DWMRI lesions were analyzed.
RESULTS
TCD spectral changes were classified into 4 patterns: (1) microemboli signals (53, 100%), (2) right-left collateral signals (31/53, 58%), (3) spectral suppression after balloon inflation (31/44, 70%), and (4) continuous spectral suppression after balloon removal (4/44, 9%). Even though microembolic signals were frequently observed during CAS, the new DWMRI lesions were more frequently observed outside of the cerebral territory (78%) rather than in the territory ipsilateral to CAS (47%). The presence of right-left collaterals was related to less severe balloon-related spectral suppression on ipsilateral MCA (p<0.05). Continuous spectral suppression appeared after stent deployment and balloon dilation and was immediately reversed after removal of the filter device.
CONCLUSION
The spectral patterns classified in the present study may prove useful in anticipating CAS procedure-related hemodynamic alterations. Close hemodynamic observation using these spectral patterns could be helpful in preventing serious complications during CAS.
目的
对经颅多普勒（TCD）频谱模式进行分类，并分析其在确定滤器保护颈动脉支架置入术（CAS）过程中发生的血流动力学改变中的意义。
方法
回顾了 53 例（男 45 例，平均年龄 67.6±8.3 岁）患者的大脑中动脉（MCA）监测和 CAS 后弥散加权磁共振成像（DWMRI）数据，这些患者在 CAS 前接受了 TCD 评估，并在手术过程中进行了 TCD 监测。根据 CAS 不同阶段后发生的血流动力学变化对 TCD 频谱模式进行分类。分析了频谱模式与新的 DWMRI 病变的频率和位置之间的关系。
结果
TCD 频谱变化分为 4 种模式：（1）微栓子信号（53 例，100%），（2）右-左侧支信号（31/53，58%），（3）球囊充气后频谱抑制（31/44，70%），和（4）球囊取出后连续频谱抑制（4/44，9%）。尽管在 CAS 过程中经常观察到微栓子信号，但新的 DWMRI 病变更多地发生在大脑区域以外（78%），而不是 CAS 同侧区域（47%）。右-左侧支的存在与同侧 MCA 球囊相关频谱抑制程度较轻相关（p<0.05）。连续的频谱抑制出现在支架放置和球囊扩张后，并在滤器装置取出后立即逆转。
结论
本研究中分类的频谱模式可能有助于预测 CAS 相关血流动力学改变。使用这些频谱模式进行密切的血流动力学观察有助于预防 CAS 过程中的严重并发症。
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