Huang T, Zou S L, Shen X, Jin J, Bai J, Wu J J, Wang L, Jiang Q J, Qu L F
Department of Vascular and Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China.
Zhonghua Yi Xue Za Zhi. 2022 Mar 22;102(11):781-786. doi: 10.3760/cma.j.cn112137-20210605-01285.
To evaluate the value of color Doppler ultrasound and digital subtraction angiography (DSA) in evaluating the level of carotid bifurcation and the morphology of extracranial internal carotid artery in patients with atherosclerotic carotid stenosis. The carotid artery examination data of 186 patients with atherosclerotic carotid stenosis who underwent carotid DSA and color Doppler ultrasound in Shanghai Changzheng Hospital from July 2017 to June 2019 were retrospectively analyzed, including 154 males and 32 females, with ages ranging from 36 to 84 (66±8) years old. The correlation between the position of carotid bifurcation and the level of cervical spine, the distance from the position of carotid bifurcation to mandibular angle, the correlation of the level of bifurcation with the length of neck, and the incidence of carotid distortion were analyzed. DSA showed that the most common position of carotid bifurcation was at C3 level on the left [37.3% (56/150)], and at C3-C4 level on the right [33.6% (42/125)], and the highest position was at C2 level on the left, and at C2-C3 levels on the right, while the lowest level on both sides was at C5 level. The incidence of high bifurcation of left carotid artery (C3 and above) was 46% (69/150), which was higher than that of right carotid artery [21.6% (27/125), <0.001]. The incidence of high carotid bifurcation in men and women was 33.2% (76/229) and 43.5% (20/46), respectively, with no significant difference ( = 0.182). Carotid ultrasound showed that the distance between the left carotid bifurcation and the mandibular angle was (3.0±1.3) cm, which was shorter than that on the right [(3.4±1.2) cm] (<0.001). The distance between carotid bifurcation and mandibular angle in men and women was (3.2±1.2) cm and (3.3±1.0) cm, respectively, with no significant difference ( = 0.093). There was no significant correlation between carotid bifurcation level and carotid length (right: = 0.02, = 0.091; left: = 0.01, = 0.927). The incidence of carotid artery distortion was 28.1% (9/32) in women and 15.6% (24/154) in men, with no significant difference ( = 0.091). The incidence of right carotid artery distortion in high bifurcation group was 59.3% (16/27), which was higher than that in non-high bifurcation group [3.1% (3/98)] (<0.001). Likewise, the incidence of left carotid artery distortion in high bifurcation group was 30.4% (21/69), which was higher than that in non-high bifurcation group [2.5% (2/81)] (0.001). The bifurcation position of left carotid artery in patients with atherosclerotic carotid stenosis is higher than that of the right. Patients with high bifurcation of carotid artery are more likely to be complicated with carotid distortion. Preoperative color doppler ultrasound combined with DSA can evaluate the distortion of extracranial carotid artery, thereby providing reference for the selection of surgical methods.
评估彩色多普勒超声和数字减影血管造影（DSA）在评估动脉粥样硬化性颈动脉狭窄患者颈动脉分叉水平及颅外颈内动脉形态方面的价值。回顾性分析2017年7月至2019年6月在上海长征医院行颈动脉DSA及彩色多普勒超声检查的186例动脉粥样硬化性颈动脉狭窄患者的颈动脉检查资料，其中男性154例，女性32例，年龄36～84（66±8）岁。分析颈动脉分叉位置与颈椎水平、颈动脉分叉位置至下颌角的距离、分叉水平与颈部长度的相关性以及颈动脉扭曲的发生率。DSA显示，颈动脉分叉最常见的位置左侧为C3水平[37.3%（56/150）]，右侧为C3 - C4水平[33.6%（42/125）]，最高位置左侧为C2水平，右侧为C2 - C3水平，两侧最低水平均为C5水平。左侧颈动脉高分叉（C3及以上）发生率为46%（69/150），高于右侧颈动脉[21.6%（27/125），<0.001]。男性和女性颈动脉高分叉发生率分别为33.2%（76/229）和43.5%（20/46），差异无统计学意义（ = 0.182）。颈动脉超声显示，左侧颈动脉分叉与下颌角的距离为（3.0±1.3）cm，短于右侧[（3.4±1.2）cm]（<0.001）。男性和女性颈动脉分叉与下颌角的距离分别为（3.2±1.2）cm和（3.3±1.0）cm，差异无统计学意义（ = 0.093）。颈动脉分叉水平与颈动脉长度无明显相关性（右侧： = 0.02， = 0.091；左侧： = 0.01， = 0.927）。女性颈动脉扭曲发生率为28.1%（9/32），男性为15.6%（24/154），差异无统计学意义（ = 0.091）。高分叉组右侧颈动脉扭曲发生率为59.3%（16/27），高于非高分叉组[3.1%（3/98）]（<0.001）。同样，高分叉组左侧颈动脉扭曲发生率为30.4%（21/69），高于非高分叉组[2.5%（2/81）]（0.001）。动脉粥样硬化性颈动脉狭窄患者左侧颈动脉分叉位置高于右侧。颈动脉高分叉患者更易合并颈动脉扭曲。术前彩色多普勒超声联合DSA可评估颅外颈动脉扭曲情况，从而为手术方式的选择提供参考。
