Shakur Sophia F, Amin-Hanjani Sepideh, Bednarski Caroline, Du Xinjian, Aletich Victor A, Charbel Fady T, Alaraj Ali
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
Neurosurgery. 2015 Mar;76(3):330-6. doi: 10.1227/NEU.0000000000000618.
Carotid artery stenting is an endovascular treatment option for patients with extracranial carotid stenosis. However, intracranial blood flow changes following stenting have not been established.
To determine the effects of stenting on intracranial blood flow.
Records of patients who underwent stenting at our institution between 2004 and 2012 and had flow rates obtained pre- and poststenting by the use of quantitative magnetic resonance angiography were retrospectively reviewed. Percentage stenosis, stenosis length, and minimum vessel diameter were measured from cerebral angiography images.
Eighteen patients were included. Mean age was 65 years with 67% presenting with symptomatic stenosis. Degree of stenosis ranged from 60% to 90%. Internal carotid artery (ICA) mean flow improved significantly poststenting from 174.9 ± 83.6 mL/min to 250.7 ± 91.2 mL/min (P = .011). Ipsilateral middle cerebral artery (MCA) flow, however, was not significantly altered poststenting (107.8 ± 41.6 mL/min vs 114.3 ± 36.3 mL/min; P = .28). Univariate analysis revealed that improved minimum vessel diameter after stenting, but not percentage stenosis (P = .18) or stenosis length (P = .45), is significantly associated with increased ICA flow (P = .02). However, improved percentage stenosis, stenosis length, minimum vessel diameter, and ICA flow poststenting were not significantly associated with increased MCA flow (P = .64, .38, .13, .37, respectively).
ICA flow was compromised at baseline, improving 43% on average poststenting. Increased minimum vessel diameter was the factor most significantly associated with increased flow. Conversely, MCA flow was not significantly compromised at baseline nor altered after stenting, suggesting compensatory intracranial collateral supply prestenting that redistributes following ICA revascularization.
颈动脉支架置入术是颅外颈动脉狭窄患者的一种血管内治疗选择。然而，支架置入术后颅内血流的变化尚未明确。
确定支架置入术对颅内血流的影响。
回顾性分析2004年至2012年在我院接受支架置入术且术前和术后通过定量磁共振血管造影获得流速的患者记录。从脑血管造影图像测量狭窄百分比、狭窄长度和最小血管直径。
纳入18例患者。平均年龄65岁，67%表现为有症状的狭窄。狭窄程度为60%至90%。颈内动脉（ICA）平均血流在支架置入术后显著改善，从174.9±83.6 mL/分钟增至250.7±91.2 mL/分钟（P = 0.011）。然而，同侧大脑中动脉（MCA）血流在支架置入术后无显著改变（107.8±41.6 mL/分钟对114.3±36.3 mL/分钟；P = 0.28）。单因素分析显示，支架置入术后最小血管直径的改善与ICA血流增加显著相关，但狭窄百分比（P = 0.18）或狭窄长度（P = 0.45）并非如此（P = 0.02）。然而，支架置入术后狭窄百分比、狭窄长度、最小血管直径和ICA血流的改善与MCA血流增加无显著相关性（分别为P = 0.64、0.38、0.13、0.37）。
ICA血流在基线时受损，支架置入术后平均改善43%。最小血管直径增加是与血流增加最显著相关的因素。相反，MCA血流在基线时无显著受损，支架置入术后也未改变，提示支架置入术前存在代偿性颅内侧支供应，在ICA血管重建后重新分布。
