经颅多普勒超声（TCD）/经颅彩色多普勒超声（TCCD）对有或无对侧颈动脉闭塞患者进行单侧颈动脉支架置入术后早期血流动力学监测
Hemodynamic Surveillance of Unilateral Carotid Artery Stenting in Patients With or Without Contralateral Carotid Occlusion by TCD/TCCD in the Early Stage Following Procedure.
作者信息
Yan Ziguang, Yang Min, Niu Guochen, Zhang Bihui, Tong Xiaoqiang, Guo Hongjie, Zou Yinghua
机构信息
Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.
出版信息
Front Neurol. 2019 Sep 4;10:958. doi: 10.3389/fneur.2019.00958. eCollection 2019.
To evaluate the cerebral hemodynamic variations in patients with unilateral carotid artery stenosis and contralateral carotid occlusion (CCO) in hours following carotid artery stenting (CAS) by transcranial Doppler (TCD) or transcranial color-code Doppler (TCCD). Sixty-five consecutive patients who underwent unilateral CAS were enrolled. Among them, 14 patients had ipsilateral severe stenosis and CCO (CCO group) while the other 51 patients had only unilateral severe carotid stenosis without CCO (UCS group). All patients underwent TCD or TCCD monitoring before, at 1 and 3 h after CAS. We monitored bilateral middle cerebral artery (MCA) peak systolic velocity (PSV), pulsatility index (PI), and blood pressure (BP), and compared that data between two groups. In UCS group, ipsilateral MCA PSV increased relative to baseline at 1 h (96 ± 30 vs. 85 ± 26 cm/s, 15%, < 0.001) and 3 h (97 ± 29 vs. 85 ± 26 cm/s, 17%, < 0.001) following CAS. Significant PI increases were observed at 1 and 3 h following CAS on the ipsilateral side. In CCO group, ipsilateral MCA PSV increased relative to baseline at 1 h (111 ± 30 vs. 83 ± 26 cm/s, 35%, < 0.001) and 3 h (107 ± 28 vs. 83 ± 26 cm/s, 32%, <0.001) following CAS. The magnitude of ipsilateral MCA PSV increase was significantly higher in CCO group compared with UCS group at 1 h ( = 0.002) and 3 h ( = 0.024) following CAS, while BP similarly decreased between the two groups. On the contralateral side, significant MCA PSV increases were observed following CAS in CCO group but not in UCS group. Bilateral MCA PSV increases were higher in patients with a stenosis degree of ≥90% than in patients with stenosis degree of 70-89% only in CCO group. The ipsilateral MCA PSV and PI increase moderately in the initial hours after unilateral CAS in patients without CCO. In patients with CCO, the ipsilateral, and contralateral MCA PSV increase significantly in the early stage following CAS. CCO is a factor of the increased blood flow velocity in ipsilateral MCA after unilateral CAS.
通过经颅多普勒（TCD）或经颅彩色编码多普勒（TCCD）评估单侧颈动脉狭窄合并对侧颈动脉闭塞（CCO）患者在颈动脉支架置入术（CAS）后数小时内的脑血流动力学变化。连续纳入65例行单侧CAS的患者。其中，14例患者存在同侧严重狭窄和CCO（CCO组），另外51例患者仅存在单侧严重颈动脉狭窄而无CCO（UCS组）。所有患者在CAS术前、术后1小时和3小时均接受TCD或TCCD监测。我们监测双侧大脑中动脉（MCA）的收缩期峰值流速（PSV）、搏动指数（PI）和血压（BP），并比较两组之间的数据。在UCS组中，CAS术后1小时（96±30 vs. 85±26 cm/s，15%，<0.001）和3小时（97±29 vs. 85±26 cm/s，17%，<0.001）时，同侧MCA的PSV相对于基线升高。CAS术后1小时和3小时，同侧PI显著升高。在CCO组中，CAS术后1小时（111±30 vs. 83±26 cm/s，35%，<0.001）和3小时（107±28 vs. 83±26 cm/s，32%，<0.001）时，同侧MCA的PSV相对于基线升高。CAS术后1小时（P = 0.002）和3小时（P = 0.024）时，CCO组同侧MCA PSV升高幅度显著高于UCS组，而两组间BP同样下降。在对侧，CCO组CAS术后观察到MCA PSV显著升高，而UCS组未观察到。仅在CCO组中，狭窄程度≥90%的患者双侧MCA PSV升高高于狭窄程度为70 - 89%的患者。在无CCO的患者中，单侧CAS术后最初数小时同侧MCA的PSV和PI适度升高。在有CCO的患者中，CAS术后早期同侧和对侧MCA的PSV显著升高。CCO是单侧CAS后同侧MCA血流速度增加的一个因素。
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