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目的应用彩色多普勒血流显像(CDFI)分析颈动脉支架置入术(CAS)后残余狭窄的发生率及其影响因素。方法前瞻性纳入2008年1月—2011年12月在首都医科大学宣武医院接受CAS的患者423例(434枚支架)。术后1周内行CDFI检查。根据术后DSA影像及CDFI的结果判定残余狭窄率。分析颈动脉斑块的声波特征、形态学的变化及支架的类型(开环式和闭环式)对CAS术后残余狭窄发生率的影响。结果①术后残余狭窄的发生率为31.1%(135/434),其中98.5%(133/135)的残余狭窄率﹤50%,1.5%(2/135)残余狭窄率≥50%。②不均质回声斑块患者的残余狭窄的发生率为34.1%,高于均质回声斑块的24.8%,P<0.05。在均质回声斑块患者中,强回声斑块者残余狭窄的发生率为48.6%,高于等回声和低回声斑块组的17.9%、14.6%,P=0.002、P=0.001;不均质回声斑块患者中,斑块基底部钙化者残余狭窄的发生率为51.3%,高于无基底部斑块钙化者的28.1%,P=0.000。不规则形态斑块的患者,残余狭窄的发生率为35.7%,高于规则形态斑块者的26.1%,P=0.031。③置入开环式支架和闭环式支架后,残余狭窄的发生率分别为30.6%(110/360)、33.8%(25/74),差异无统计学意义,P=0.585。④多因素Logistic回归分析显示,基底部钙化斑块(OR=2.658,95%CI:1.598～4.560)、强回声斑块(OR=4.609,95%CI:1.994～10.657)是影响残余狭窄的独立危险因素。结论基底部钙化的不均质回声动脉粥样硬化斑块及单纯强回声斑块是造成CAS术后残余狭窄发生的独立危险因素。
Objective To analyze the incidence of residual stenosis after carotid stenting (CAS) by color Doppler flow imaging (CDFI) and its influencing factors. Methods Forty-three patients (434 stents) receiving CAS at Xuanwu Hospital, Capital Medical University from January 2008 to December 2011 were prospectively included. CDFI examination within 1 week after operation. The residual stenosis rate was determined according to the results of postoperative DSA imaging and CDFI. The effects of stenosis, morphological changes and stent types (open-loop and closed-loop) on the incidence of residual stenosis after CAS were analyzed. Results ① The incidence of postoperative residual stenosis was 31.1% (135/434). The residual stenosis rate was less than 50% in 98.5% (133/135) and ≥50% in 1.5% (2/135). ② The incidence of residual stenosis in patients with heterogeneous echogenic patches was 34.1%, which was higher than that of homogeneous echogenic patches (P <0.05). In patients with homogeneous echo patches, the incidence of residual stenosis in patients with strong echo patches was 48.6%, higher than that in the echogenic and hypoechoic patches groups (17.9%, 14.6%, P = 0.002, P = 0.001) In patients with hyperechoic plaque, the incidence of residual stenosis at plaque basal calcification was 51.3%, which was higher than 28.1% of those without basal plaque calcification (P = 0.000). In patients with irregularly shaped plaque, the incidence of residual stenosis was 35.7%, up from 26.1% of those with regular plaques, P = 0.031. ③ The incidence of residual stenosis was 30.6% (110/360) and 33.8% (25/74), respectively, with no significant difference after placement of open-loop stent and closed-loop stent, P = 0.585. (4) Multivariate Logistic regression analysis showed that calcification plaques (OR = 2.658, 95% CI: 1.598-4.560) and hyperechoic plaques (OR = 4.609, 95% CI: 1.994-10.657) were independent factors affecting residual stenosis Risk factors. Conclusions Heterogeneous echogenic atherosclerotic plaque calcification and simple hyperechoic plaque in the basal ganglia are independent risk factors for residual stenosis after CAS.