Yan Ziguang, Yang Min, Niu Guochen, Zhang Bihui, Tong Xiaoqiang, Zou Yinghua
Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.
Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.
Ann Vasc Surg. 2019 Aug;59:5-11. doi: 10.1016/j.avsg.2019.01.020. Epub 2019 Apr 19.
To evaluate the unclear cerebral hemodynamic variations in patients with and without near occlusion (NO) in hours after carotid artery stenting (CAS) by transcranial Doppler (TCD).
Data of 56 patients (11 patients with carotid artery NO and 45 patients with severe stenosis without NO) who underwent unilateral CAS were analyzed. All patients underwent TCD or transcranial color-code Doppler monitoring before CAS and again at one and three hours after the procedure. We compared bilateral middle cerebral artery peak systolic velocity (MCA-PSV), pulsatility index (PI), and blood pressure (BP) data between the two groups.
Ipsilateral MCA-PSV increased relative to baseline in the stenosis group at one hour (97 ± 30 vs. 84 ± 23 cm/s, 16%, P < 0.001) and three hours (96 ± 28 vs. 84 ± 23 cm/s, 15%, P < 0.001) after CAS. Corresponding increases were distinctly higher in the NO group than in the stenosis group at one hour (116 ± 37 vs. 80 ± 29 cm/s, 51%, P < 0.001) and three hours (113 ± 39 vs. 80 ± 29 cm/s, 46%, P = 0.001) after CAS, whereas BP decreased similarly between the two groups. The ipsilateral PI increased postsurgically in both groups, whereas contralateral MCA-PSV was unaltered.
CAS can induce a significant increase in PSV and PI in ipsilateral MCA within three hours in patients with NO or severe stenosis but absent NO. The increment of ipsilateral MCA-PSV was greater in patients with NO. TCD can facilitate BP control in the early stage after CAS in patients with NO.
通过经颅多普勒（TCD）评估颈动脉支架置入术（CAS）后数小时内有或无近乎闭塞（NO）患者的脑血流动力学变化情况。
分析56例行单侧CAS患者的数据（11例颈动脉NO患者和45例无NO的严重狭窄患者）。所有患者在CAS术前接受TCD或经颅彩色编码多普勒监测，并在术后1小时和3小时再次监测。我们比较了两组之间双侧大脑中动脉收缩期峰值流速（MCA-PSV）、搏动指数（PI）和血压（BP）数据。
狭窄组同侧MCA-PSV在CAS术后1小时（97±30 vs. 84±23 cm/s，16%，P<0.001）和3小时（96±28 vs. 84±23 cm/s，15%，P<0.001）相对于基线升高。在CAS术后1小时（116±37 vs. 80±29 cm/s，51%，P<0.001）和3小时（113±39 vs. 80±29 cm/s，46%，P=0.001），NO组相应的升高明显高于狭窄组，而两组间BP下降情况相似。两组术后同侧PI均升高，而对侧MCA-PSV未改变。
对于有NO或严重狭窄但无NO的患者，CAS可在3小时内使同侧MCA的PSV和PI显著升高。有NO患者同侧MCA-PSV的升高幅度更大。TCD有助于NO患者CAS术后早期的血压控制。
