Zhang Feng, Shi Weiliang, Xi Zhenhua, Chu Lulu, Ma Xiaodong
Department of Neurology, Haiyan People's Hospital Jiaxing, Zhejiang, China.
Medicine (Baltimore). 2025 Jan 17;104(3):e41153. doi: 10.1097/MD.0000000000041153.
This study aimed to evaluate changes in cerebral blood flow and perioperative outcomes in patients with unilateral symptomatic carotid artery stenosis before and after carotid artery stenting (CAS), providing insights to guide surgical decision-making. Ninety-six patients with moderate to severe unilateral symptomatic carotid artery stenosis (>50%) admitted to the Neurology Department of the Second Affiliated Hospital of Zhejiang University from June 2023 to April 2024 were included. All patients underwent CAS and magnetic resonance imaging, including diffusion-weighted imaging (DWI) and 3D quasi-continuous arterial spin-labeled perfusion imaging, within 3 days preoperatively and on the third postoperative day. Patients were categorized into microembolic and non-embolic groups based on the presence of new diffusion-weighted imaging hyperintensities. Newly developed diffusion-weighted imaging hyperintensities were detected in 68 patients (70.8%), with a total of 704 lesions, though only 4 cases exhibited symptoms. Most lesions were localized to the frontal-parietal cortex and subcortical areas on the affected side (60.8%) and were <3 mm in size (92.6%). Postoperatively, cerebral blood flow in the frontal-parietal lobe was significantly higher than in the temporal lobe on both the affected (50.49 ± 8.02 vs 47.94 ± 9.08, t = 2.179, P < .05) and healthy sides (50.16 ± 5.79 vs 48.00 ± 5.98, t = 3.835, P < .05). Additionally, cerebral blood flow in the affected frontal and temporal lobes significantly increased after surgery (P < .05). Preoperative frontal-parietal cerebral blood flow was lower in the microembolic group compared to the non-embolic group (P < .05). Microemboli are common after CAS but are unlikely to result from immediate hemodynamic changes. Instead, they appear to be associated with chronic preoperative hypoperfusion, which impairs cerebral blood flow regulation.
本研究旨在评估单侧症状性颈动脉狭窄患者在颈动脉支架置入术（CAS）前后脑血流的变化及围手术期结局，为指导手术决策提供依据。纳入了2023年6月至2024年4月在浙江大学医学院附属第二医院神经内科住院的96例中度至重度单侧症状性颈动脉狭窄（>50%）患者。所有患者在术前3天内及术后第3天均接受了CAS及磁共振成像检查，包括弥散加权成像（DWI）和三维准连续动脉自旋标记灌注成像。根据新的弥散加权成像高信号的有无，将患者分为微栓塞组和非栓塞组。68例患者（70.8%）检测到新出现的弥散加权成像高信号，共704个病灶，其中仅4例出现症状。大多数病灶位于患侧额叶-顶叶皮质及皮质下区域（60.8%），大小<3 mm（92.6%）。术后，患侧及健侧额叶-顶叶的脑血流均显著高于颞叶（患侧：50.49±8.02 vs 47.94±9.08，t=2.179，P<.05；健侧：50.16±5.79 vs 48.00±5.98，t=3.835，P<.05）。此外，术后患侧额叶和颞叶的脑血流显著增加（P<.05）。微栓塞组术前额叶-顶叶脑血流低于非栓塞组（P<.05）。CAS术后微栓子很常见，但不太可能由即刻血流动力学变化引起。相反，它们似乎与术前慢性低灌注有关，这会损害脑血流调节。
