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目的研究滤器保护的颈动脉支架成形术(CAS)术前、术中和术后微栓子及脑血流变化。方法对5例颈动脉严重狭窄(>70%)患者进行6次CAS,在术前、术中和术后使用M模经颅多普勒超声(TCD)监测大脑中动脉(MCA)的微栓子和脑血流。术后随访,记录新的血管性事件。结果CAS术中监测发现单纯造影时出现大量微栓子信号(MES)。此外,MES数目最多的手术操作步骤是预扩张(n=116)和支架放置(n=135,91,113,90,106,125),后扩张时MES数目相对较少(n=8,14,37,16)。术中MCA收缩期血流速度与平均血流速度比值变化发生在预扩张(46/31至76/54)和后扩张(40/26至74/49,0/0至114/69,35/24至116/71,50/36至137/86)时。术前有2例患者存在MES,术后MES消失。术后与基线相比,MCA血流速度或者搏动指数增加,术中无并发症。1例回收滤器中有脱落组织碎片。随访3～19个月,有1例新发脑梗死,位于CAS对侧。结论TCD监测可以评价滤器保护的CAS术前、术中和术后微栓子发生和脑血流变化。滤器可以过滤较大组织碎片,减少术中栓塞,而并不影响脑血流。可以通过滤器的气泡和小的固体颗粒一般不会导致临床症状的出现。
Objective To investigate preoperative, postoperative and postoperative embolism and cerebral blood flow changes of filter-protected carotid stenting (CAS). Methods Five patients with severe carotid stenosis (> 70%) underwent 6 CASs. The micro-embolism of middle cerebral artery (MCA) was monitored by M-mode transcranial Doppler sonography (TCD) before, during and after surgery Child and brain blood flow. Follow-up postoperatively recorded new vascular events. Results During intraoperative CAS monitoring, a large number of microemboli signals (MESs) were observed during simple angiography. In addition, the most frequent surgical procedures for MES were pre-dilatation (n = 116) and stent placement (n = 135,91,113,90,106,125) with a relatively small number of MES after dilation (n = 8,14,37,16). Intraoperative MCA systolic blood flow velocity and mean blood flow velocity ratio changes occurred in the pre-dilation (46/31 to 76/54) and post-dilation (40/26 to 74/49, 0/0 to 114/69, 35 / 24 to 116/71, 50/36 to 137/86). Preoperative presence of MES in 2 patients, MES disappeared. Compared with baseline, postoperative MCA blood flow velocity or pulsatility index increased, no intraoperative complications. 1 case of recovery filter shedding tissue fragments. Followed up for 3 to 19 months, one case of new cerebral infarction, contralateral CAS. Conclusions TCD monitoring can evaluate preoperative, postoperative and postoperative embolic microencapsulation and changes of cerebral blood flow in the presence of filter protection. Filters can filter larger tissue debris, reduce intraoperative embolization, and does not affect cerebral blood flow. Bubbles and small solid particles that can pass through the filter generally do not cause the appearance of clinical symptoms.