摘要
目的:应用经颅彩色多普勒超声(transcranial color Doppler ultrasound,TCCD)对颈动脉支架成形术(carotid artery stenting,CAS)术前检查,评估颅内侧支血管循环的情况,评估其准确性及相关影响因素.方法:对63例行CAS手术的患者行TCCD检查,评估前交通动脉(anterior communicating artery,ACoA)、后交通动脉(posterior communicating artery,PCoA)、眼动脉(ophthalmic artery,OA)开放的情况,并与数字减影血管造影(digital subtraction angiography,DSA)结果对比,分析导致TCCD侧支开放误诊的因素.结果:颈动脉超声提示:单侧颈动脉重度狭窄或闭塞52例,双侧颈动脉均为重度狭窄或闭塞5例,一侧颈动脉重度狭窄(或闭塞)合并另一侧颈动脉中度及以上狭窄6例.ACoA开放组诊断符合率为79.4％、灵敏度为73.9％、特异度为94.1％、误诊率为5.9％、漏诊率为26.1％、阳性预测值为97.1％、阴性预测值为57.1％;PCoA开放组分别为84.1％、92.7％、68.2％、31.8％、7.3％、84.4％、83.3％;OA 开放组分别为 88.9％、100％、78.8％、21.2％、0％、81.1％、100％.三组与DSA一致性的Kappa数值分别为0.565、0.635、0.780.采用二元Logistic回归分析,得出相关影响因素,如前交通动脉压力差小,后交通动脉或眼动脉血管走行变异(详细说明)对TCCD误诊颅内血管侧支开放均有意义,为危险因素.结论:TCCD检查在术前较准确评估颅内侧支循环情况,能够为CAS手术提供可靠依据,且对术后定期随访颅内侧支循环变化情况,是更为有效安全简捷的诊断工具.
Abstract
Objective:Application of transcranial color Doppler ultrasound(TCCD)for preoperative examination of patients undergoing carotid artery stenting(CAS),to evaluate the circulation of the medial cranial branch vessels in patients with severe stenosis or occlusion of the extracranial carotid artery,and compare it with DSA results to analyze the accuracy of TCCD in evaluating the medial cranial branch vessels and its related influencing factors.Methods:TCCD examination was performed on 63 patients undergoing CAS surgery to evaluate the opening of the anterior communicating artery(ACoA),posterior communicating artery(PCoA),and ophthalmic artery(OA),and compared with DSA results to analyze the factors leading to misdiagnosis of TCCD collateral opening.Results:carotid ultrasound showed severe stenosis or occlusion of unilateral carotid artery in 52 cases and severe stenosis or occlusion of bilateral carotid artery in 5 cases,there were 6 cases with severe stenosis(or occlusion)of one carotid artery and moderate stenosis of the other carotid artery.In ACoA Group,the diagnostic accuracy was 79.4％,the sensitivity was 73.9％,the specificity was 94.1％,the misdiagnosis rate was 5.9％,the missed diagnosis rate was 26.1％,the positive predictive value was 97.1％,the negative predictive value was 57.1％.In PCoA Group,the diagnostic accuracy was 84.1％,the sensitivity was 92.7％,the specificity was 68.2％,the misdiagnosis rate was 31.8％,the missed diagnosis rate was 7.3％,the positive predictive value was 84.4％,the negative predictive value was 83.3％.The diagnostic accuracy,sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,positive predictive value and negative predictive value of OA Group were 88.9％,100％,78.8％,21.2％,0％,81.1％and 100％,respectively.The Kappa values of the three groups were 0.565,0.635 and 0.780.Using binary Logistic regression analysis,it was found that the relevant influencing factors have significant implications for the misdiagnosis of intracranial vascular collateral opening in TCCD,which is a risk factor.Conclusions:TCCD examination can accurately evaluate the condition of the medial cranial branch circulation before surgery,provide reliable basis for CAS surgery,and can be applied to regular follow-up of patients with changes in the medial cranial branch circulation after surgery.It is a more effective,safe,and simple diagnostic tool.
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