SPECT 对症状性颅内动脉狭窄支架成形术的疗效评价

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。

Therapeutic Evaluation of Intravascular Stenting in Intracranial Atherosclerotic Stenosis by SPECT Brain Perfusion Imaging

Objective: By use of SPECT brain perfusion imaging,the therapeutic effects of symptomatic intracranial atherosclerotic stenosis would be assessed before and after intracranial stent-assisted angioplasty.Methods: 42 cases of symptomatic intracranial atherosclerotic stenosis confirmed by DSA(the degree of stenosis> 50%) patients were divided into hypoperfusion group and normal perfusion group through preoperative SPECT brain perfusion imaging before intracranial stent-assisted angioplasty.3 months after operation,the patients were examined with SPECT brain perfusion imaging again and made the evaluation of the cerebral hemodynamic changes.Through the score of mRS of the two groups were evaluated before surgery and after 1-year follow-up,we compared low perfusion group with normal perfusion group in long-term efficacy.Results: The incidence of symptoms was statistically related to perfusion: low perfusion commonly caused ischemic stroke and ischemic events with normal perfusion were generally TIA(P<0.01).The perfusion was improved significantly(P <0.01) in low perfusion group compared with preoperative.The incidence of recurrent TIA in normal perfusion group is significantly higher than low perfusion group(P <0.05).There is a significant difference between preoperative Modified Rankin Scales and postoperative for the low perfusion group(P <0.05).Conclusion: Intracranial stent assisted angioplasty could clearly improve the perfusion of the intracranial regions with hypoperfusion,and prevention of ischemic events in symptomatic intracranial atherosclerotic stenosis had a better effect in stenotic-related patients with low perfusion regions.Stent-assisted angioplasty can improve neurological function of the group for the low perfusion group.Therefore,stenotic-related patients with low perfusion regions have more operative indications for intracranial stent-assisted angioplasty.