有症状患者行颈动脉支架置入术后，脑微灌注的计算机断层扫描指标长期改善。

Computed tomography indicators of cerebral microperfusion improve long term after carotid stenting in symptomatic patients.

作者信息

Winklewski Pawel J, Kaszubowski Mariusz, Halena Grzegorz, Sabisz Agnieszka, Chwojnicki Kamil, Dzierżanowski Jarosław, Piskunowicz Maciej, Kurhaluk Natalia, Szurowska Edyta, Szarmach Arkadiusz

机构信息

1Department of Human Physiology, Medical University of Gdansk, Gdańsk, Poland; 2Department of Clinical Anatomy and Physiology, Pomeranian University of Slupsk, Słupsk, Poland; 32-nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland.

Department of Economic Sciences, Gdansk University of Technology, Gdańsk, Poland.

出版信息

Acta Biochim Pol. 2019 Apr 8;66(2):229-236. doi: 10.18388/abp.2018_2793.

DOI:10.18388/abp.2018_2793

PMID:30957796

Abstract

OBJECTIVES

We tested the hypothesis that computed tomography (CT) perfusion markers of cerebral microcirculation would improve 36 months after internal carotid artery stenting for symptomatic carotid stenosis while results obtained 6-8 weeks after the stenting procedure would yield a predictive value.

METHODS

We recruited consecutive eligible patients with >70% symptomatic carotid stenosis with a complete circle of Willis and normal vertebral arteries to the observational cohort study. We detected changes in the cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and permeability surface area-product (PS) before and after carotid stenting. We have also compared the absolute differences in the ipsilateral and contralateral CT perfusion markers before and after stenting. The search for regression models of "36 months after stenting" results was based on a stepwise analysis with bidirectional elimination method.

RESULTS

A total of 34 patients completed the 36 months follow-up (15 females, mean age of 69.68±S.D. 7.61 years). At 36 months after stenting, the absolute values for CT perfusion markers had improved: CBF (ipsilateral: +7.76%, contralateral: +0.95%); CBV (ipsilateral: +5.13%, contralateral: +3.00%); MTT (ipsilateral: -12.90%; contralateral: -5.63%); TTP (ipsilateral: -2.10%, contralateral: -4.73%) and PS (ipsilateral: -35.21%, contralateral: -35.45%). MTT assessed 6-8 weeks after stenting predicted the MTT value 36 months after stenting (ipsilateral: R2=0.867, contralateral R2=0.688).

CONCLUSIONS

We have demonstrated improvements in CT perfusion markers of cerebral microcirculation health that persist for at least 3 years after carotid artery stenting in symptomatic patients. MTT assessed 6-8 weeks after stenting yields a predictive value.

摘要

目的

我们检验了这样一个假设，即对于有症状的颈动脉狭窄患者，在进行颈内动脉支架置入术后36个月，脑微循环的计算机断层扫描（CT）灌注指标会有所改善，而在支架置入术后6 - 8周所获得的结果将具有预测价值。

方法

我们招募了连续符合条件的、有症状的颈动脉狭窄程度>70%、 Willis环完整且椎动脉正常的患者进入观察性队列研究。我们检测了颈动脉支架置入前后脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）、达峰时间（TTP）和通透表面积乘积（PS）的变化。我们还比较了支架置入前后同侧和对侧CT灌注指标的绝对差异。对“支架置入后36个月”结果的回归模型搜索基于双向淘汰法的逐步分析。

结果

共有34例患者完成了36个月的随访（15例女性，平均年龄69.68±标准差7.61岁）。在支架置入后36个月，CT灌注指标的绝对值有所改善：CBF（同侧：+7.76%，对侧：+0.95%）；CBV（同侧：+5.13%，对侧：+3.00%）；MTT（同侧：-12.90%；对侧：-5.63%）；TTP（同侧：-2.10%，对侧：-4.73%）和PS（同侧：-35.21%，对侧：-35.45%）。支架置入后6 - 8周评估的MTT可预测支架置入后第36个月的MTT值（同侧：R2 = 0.867，对侧R2 = 0.688）。