Yao J, van Sambeek M R, Dall'Agata A, van Dijk L C, Kozakova M, Koudstaal P J, Roelandt J R
Departments of Cardiology, Thoraxcenter and Academic Hospital Dijkzigt, Erasmus University, Rotterdam, the Netherlands.
Stroke. 1998 Oct;29(10):2026-31. doi: 10.1161/01.str.29.10.2026.
It has been proved that symptomatic patients with severe carotid stenosis benefit from endarterectomy. Currently used methods for quantitation of the severity of carotid stenosis have limitations, and the impact of endarterectomy on the operated region of carotid artery remains unknown. The purpose of this study was to examine the accuracy of a 3-D ultrasound system for quantitation of stenotic lesions and to evaluate changes in regional vessel volume and cross-sectional area after carotid endarterectomy.
We studied 14 patients with both carotid angiography and 3-D ultrasound. Of 13 patients who underwent surgery, 12 were reexamined with 3-D ultrasound after surgery. The length and volume of 20 randomly selected plaques were measured from 3-D data sets. The severity of stenosis was quantified by 3-D ultrasound using both a diameter method and an area method on cross-sectional views at the most stenotic site; the results were then compared with those from carotid angiography. The segmental vessel volume and average cross-sectional area of the operated artery both before and after endarterectomy were measured from 3-D ultrasound data.
Good correlation was obtained between 3-D ultrasound and carotid angiography in quantitative analysis of carotid stenosis (SEE=12.4%, r=0.76, and mean difference=7.0+/-12.3% with the diameter method; SEE=10.5%, r=0.82, and mean difference=1.8+/-10.5% with the area method by 3-D ultrasound). 3-D ultrasound had excellent reproducibility and small intraobserver and interobserver variability in plaque length and volume measurements. No significant changes in segmental vessel volume and average cross-sectional area of the operated artery were observed after surgery in patients with suture closure. However, a significant increase in segmental vessel volume was obtained in patients with polyfluorethylene patches applied to the surgical opening of the artery.
3-D ultrasound can be used for both qualitative and quantitative analysis of plaques in the carotid artery and to detect and quantify significant carotid stenosis. Its volumetric potential has important clinical implications in serial follow-up studies for observing the progression or regression of stenotic lesions and for evaluating the outcome of interventional procedures such as endarterectomy or stent placement.
已证实有症状的重度颈动脉狭窄患者可从动脉内膜切除术获益。目前用于定量评估颈动脉狭窄严重程度的方法存在局限性，且动脉内膜切除术对颈动脉手术区域的影响尚不清楚。本研究的目的是检验三维超声系统定量评估狭窄病变的准确性，并评估颈动脉内膜切除术后局部血管容积和横截面积的变化。
我们研究了14例接受颈动脉血管造影和三维超声检查的患者。在13例接受手术的患者中，12例术后接受了三维超声复查。从三维数据集中测量20个随机选取斑块的长度和容积。在最狭窄部位的横断面视图上，采用直径法和面积法通过三维超声定量评估狭窄严重程度；然后将结果与颈动脉血管造影结果进行比较。从三维超声数据测量动脉内膜切除术前、后手术动脉的节段血管容积和平均横截面积。
在颈动脉狭窄的定量分析中，三维超声与颈动脉血管造影之间具有良好的相关性（直径法：SEE = 12.4%，r = 0.76，平均差异 = 7.0±12.3%；三维超声面积法：SEE = 10.5%，r = 0.82，平均差异 = 1.8±10.5%）。三维超声在斑块长度和容积测量方面具有出色的可重复性以及较小的观察者内和观察者间变异性。采用缝合闭合的患者术后手术动脉的节段血管容积和平均横截面积未观察到显著变化。然而，在动脉手术开口处应用聚氟乙烯补片的患者节段血管容积显著增加。
三维超声可用于颈动脉斑块的定性和定量分析，以及检测和定量评估显著的颈动脉狭窄。其容积测量潜能在观察狭窄病变进展或消退的系列随访研究以及评估诸如动脉内膜切除术或支架置入术等介入治疗效果方面具有重要的临床意义。
