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目的评价经颅多普勒(TCD)在颅内动脉狭窄支架成形术前后及再狭窄监测中的应用。方法85例脑梗死或短暂性脑缺血发作(TIA)患者,经数字减影血管造影(DSA)检查证实为颅内动脉重度狭窄。在支架置入术前、术后3 d及术后半年进行TCD检查,检测大脑中动脉(MCA)、颈内动脉终末段(ICA1)、椎动脉(VA)、基底动脉(BA)的血流动力学指标收缩峰流速(Vs)、声频等。结果85例患者术前术后DSA及TCD检查符合率为100%。3例术后半年TCD复查诊断为再狭窄,DSA检查3例患者支架内狭窄>50%。与术前比较,85例患者术后3 d MCA、ICA1、VA及BA的Vs明显下降,P<0.01,差异有统计学意义;涡流、杂音消失。术后半年TCD复查,与术后3 d比较,P值分别为:0.461、0.968、0.974及1.000,差异无统计学意义。结论TCD是理想判定颅内血管内支架成形术后疗效及随访的首选检测方法。
Objective To evaluate the application of transcranial Doppler (TCD) in monitoring intracranial arterial stenosis before and after stent restenosis. Methods Eighty-five patients with cerebral infarction or transient ischemic attack (TIA) were confirmed as severe intracranial stenosis by digital subtraction angiography (DSA). TCD was performed at 3 days and 6 months after stent implantation to detect the blood of middle cerebral artery (MCA), internal carotid artery (ICA1), vertebral artery (VA) and basilar artery (BA) Flow Index contraction peak flow velocity (Vs), audio and so on. Results 85 cases of patients with preoperative and postoperative DSA and TCD examination was 100%. Three cases of TCD were diagnosed as restenosis at six months after operation, and the stent stenosis was> 50% in three patients undergoing DSA. Compared with the preoperative values, the Vs of MCA, ICA1, VA and BA in 85 patients decreased significantly after 3 days of operation, P <0.01, the difference was statistically significant; eddy current and murmur disappeared. Six months after operation, TCD was compared with 3 days after operation. The P values were 0.461, 0.968, 0.974 and 1.000 respectively, with no significant difference. Conclusions TCD is the first choice for the determination of efficacy and follow-up after intracranial endovascular stent angioplasty.