高分辨率磁共振血管壁成像在慢性颈内动脉闭塞血管再通治疗中的应用

doi:10.3969/j.issn.1672-6731.2020.06.004

摘要/Abstract

摘要：

目的探讨高分辨率磁共振血管壁成像（HR-VWI）在慢性颈内动脉闭塞血管再通治疗中的应用价值。方法 2018年3月至2019年9月采用血管再通治疗11例症状性慢性颈内动脉闭塞患者，术前根据HR-VWI所示闭塞段起止部位以及闭塞段有无残腔、腔内血栓和动脉夹层分为Ⅰ型闭塞（眼段闭塞）、Ⅱ型闭塞（起始部至床突段及其近端颅内段闭塞）和Ⅲ型闭塞（起始部至眼段及其以远闭塞），以及A型闭塞（有残腔但无腔内血栓和动脉夹层）、B型闭塞（有残腔且有腔内血栓和动脉夹层）、C型闭塞（无残腔且无腔内血栓和动脉夹层）和D型闭塞（无残腔但有腔内血栓和动脉夹层），并与术前和术中实时DSA对比，记录血管再通率、围手术期并发症和预后。结果术前HR-VWI分型Ⅰ型闭塞2例、Ⅱ型闭塞6例、Ⅲ型闭塞3例，A型闭塞4例、B型闭塞2例、C型闭塞1例、D型闭塞2例；与术中DSA相比，术前HR-VWI对残腔、腔内血栓和动脉夹层的阳性检出率为10/11，余1例（1/11）HR-VWI分型Ⅲ型闭塞患者经DSA证实为Ⅱ型闭塞。10例（10/11）血管再通成功，1例失败病例为HR-VWI分型Ⅲ-C型闭塞；2例（2/11）出现围手术期并发症。术后1和3个月病情好转者为6和7例、稳定为5和4例；术后6个月1例发生支架内再狭窄。结论术前HR-VWI显示闭塞段有残腔提示血管再通成功率和手术安全性较高，管腔内有血栓增加围手术期并发症风险，但不降低血管再通成功率和预后。

关键词: 动脉闭塞性疾病, 颈内动脉, 血管成形术, 支架, 磁共振成像

Abstract:

Objective To explore the application value of high-resolution magnetic resonance imaging vascular wall imaging (HR-VWI) in endovascular recanalization of chronic internal carotid artery occlusion (CICAO). Methods A total of 11 patients with symptomatic CICAO were treated by recanalization from March 2018 to September 2019. The original and ferminal part of occlusion, and occlusion segment with or without residual lumen, intracavitary thrombosis and arterial dissection were shown to classify according to preoperative HR-VWI. TypeⅠ occlusion (ocular segment occlusion), typeⅡ occlusion[occlusion of the internal carotid artery (ICA) bulb to the clinoid process and its proximal intracranial segment] and type Ⅲ occlusion (occlusion of the ICA bulb to the ocular segment and beyond), and type A occlusion (with residual lumen but without thrombosis or arterial dissection), type B occlusion (residual lumen, thrombus and arterial dissection in residual lumen), type C occlusion (no residual lumen and no thrombus and arterial dissection) and type D occlusion (no residual lumen but with intracavitary thrombosis and arterial dissection) were recorded by with preoperative and intraoperative DSA. The recanalization rate, perioperative complications and prognosis were recorded. Results The preoperative HR-VWI showed typeⅠ occlusion in 2 cases, typeⅡ occlusion in 6 cases and typeⅢ occlusion in 3 cases, and type A occlusion in 4 cases, type B occlusion in 2 cases, type C occlusion in one case and type D occlusion in 2 cases. Compared with intraoperative DSA, the positive detection rate of HR-VWI for residual lumen, intracavitary thrombosis and arterial dissection was 10/11. One case (1/11) preoperative HR-VWI classification was type Ⅲ occlusion which confirmed by intraoperative DSA really was typeⅡocclusion. A total of 10 patients (10/11) for recanalization, one failure case was HR-VWI classification type Ⅲ-C. Perioperative complications occurred in 2 patients (2/11). Six and 7 patients improved in the first and third month after surgery, and 5 and 4 patients were stable, one patient developed in-stent restenosis in the sixth month after the operation. Conclusions Preoperative HR-VWI showed residual lumen in occlusion segment indicated higher success rate of recanalization and safety, and thrombosis in the residual lumen increased the risk of perioperative complications, but did not reduce the success rate and prognosis of recanalization.

Key words: Arterial occlusive diseases, Carotid artery,internal, Angioplasty, Stents, Magnetic resonance imaging

侯延伟, 张合亮, 郭再玉, 夏爽, 赵伟, 柴圣婷, 赵莲花, 赵卫华, 张洪武, 姜佳凤. 高分辨率磁共振血管壁成像在慢性颈内动脉闭塞血管再通治疗中的应用[J]. 中国现代神经疾病杂志, 2020, 20(6): 476-488.

HOU Yan-wei, ZHANG He-liang, GUO Zai-yu, XIA Shuang, ZHAO Wei, CHAI Sheng-ting, ZHAO Lian-hua, ZHAO Wei-hua, ZHANG Hong-wu, JIANG Jia-feng. Application of high-resolution magnetic resonance imaging vascular wall imaging in endovascular recanalization of chronic internal carotid artery occlusion[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(6): 476-488.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I6/476

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2 高分辨率磁共振血管壁成像在慢性颈内动脉闭塞血管再通治疗中的应用

Application of high-resolution magnetic resonance imaging vascular wall imaging in endovascular recanalization of chronic internal carotid artery occlusion

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2 高分辨率磁共振血管壁成像在慢性颈内动脉闭塞血管再通治疗中的应用

Application of high-resolution magnetic resonance imaging vascular wall imaging in endovascular recanalization of chronic internal carotid artery occlusion

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