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目的:通过SPECT脑血流灌注显像,对症状性颅内动脉粥样硬化性狭窄行颅内支架成形术,进行血流动力学的疗效评价。方法:对42例症状性颅内动脉粥样硬化性狭窄(狭窄程度>50%)患者,术前通过SPECT,分为低灌注组和正常灌注组。术后3月复查SPECT,做出血流动力学的疗效评价。通过术前及术后1年mRS评分,比较两组的远期疗效。结果:低灌注组发病症状一般为缺血性卒中,正常灌注组一般为TIA(P<0.01)。低灌注组术后血流灌注较术前改善明显(P<0.01)。正常灌注组复发性TIA的发生率较低灌注组高(P<0.05)。低灌注组术前术后mRS评分有统计学差异(P<0.05)。结论:颅内支架成形术可以明确改善颅内低灌注区的血流灌注,对低灌注组术后缺血事件的预防效果好,并有改善神经功能作用。因此,存在颅内低灌注区的患者更具有颅内支架成形术的手术适应症。
OBJECTIVE: To evaluate the hemodynamic effect of SPECT cerebral perfusion imaging and intracranial stenting for symptomatic intracranial atherosclerotic stenosis. Methods: Forty-two patients with symptomatic intracranial atherosclerotic stenosis (stenosis> 50%) were divided into low-perfusion group and normal perfusion group by SPECT preoperatively. Review of SPECT after 3 months to make hemodynamic evaluation. Preoperative and postoperative 1 year mRS score, long-term efficacy of the two groups were compared. Results: The symptoms of hypoperfusion group were generally ischemic stroke. TIA was generally used in normal perfusion group (P <0.01). The blood perfusion in the low perfusion group was significantly improved compared with that before operation (P <0.01). The incidence of recurrent TIA in the normal perfusion group was higher than that in the low perfusion group (P <0.05). The preoperative and postoperative mRS scores in the low perfusion group were significantly different (P <0.05). Conclusion: Intracranial stenting can obviously improve the perfusion in intracranial hypoperfusion area. It has a good preventive effect on postoperative ischemic events in hypoperfusion group and has the effect of improving neurological function. Therefore, patients with intracranial hypoperfusion are more likely to have surgical indications for intracranial stenting.