Objective:To investigate the characteristics of lumen structure and intracranial and extracranial hemodynamic parameters in patients with internal carotid artery occlusion (ICAO) in acute and chronic stages by combining carotid Doppler ultrasound (CDU) and transcranial color Doppler (TCCD).Methods:Patients admitted to the Department of Neurology or Neurosurgery of Xuanwu Hospital of Capital Medical University due to ICAO-related cerebral infarction from September 2017 to October 2021 were retrospectively and consecutively enrolled. According to the course of disease, the ICAO patients were divided into acute (≤4 weeks) and chronic (>4 weeks) groups. CDU and TCCD were used to detect the carotid lumen structure and intracranial and external arterial blood flow parameters in ICAO patients. The characteristic parameters were compared between the acute stage group and chronic stage group. The risk factors related to the acute course of ICAO were identified by univariate and Logistic regression analyses.Results:A total of 386 ICAO-related cerebral infarction patients were included, including 165 in the acute stage group and 221 in the chronic stage group. The proportion of women in the acute stage group was 13.3%, higher than that of the chronic phase group (6.8%, P=0.031). The incidence of coronary heart disease in the acute stage group was 26.1%, which was higher than that of the chronic stage group (16.3%, P=0.019). The proportion of hypoechoic plaques in the acute phase group was higher than that of the chronic stage group (73.3% vs 58.4%, P=0.002). The mean pulsatility index of the middle cerebral artery in the acute stage group was 0.61±0.12, which was lower than that of the chronic phase group (0.63±0.14, P=0.037). Logistic multivariate regression analysis demonstrated that female gender (odds ratio [OR]: 2.124, 95% confidence interval [CI]: 1.042-4.331, P=0.038), history of coronary heart disease (OR: 2.063, 95%CI: 1.227-3.470, P=0.006), mainly hypoechoic plaques (OR: 2.093, 95%CI: 1.332-3.291, P=0.001), and low pulsatility index of the affected middle cerebral artery (OR: 0.183, 95%CI: 0.036-0.930, P=0.041) were independent risk factors for the acute course of ICAO patients.Conclusions:The characteristics of lumen structure and intracranial hemodynamics are different between patients with acute and chronic ICAO. CDU combined with TCCD can evaluate the characteristics of patients' lesions and help clinicians make treatment decisions.

目的 探索急性期和慢性期颈内动脉闭塞(ICAO)患者侧支循环对颅内血流灌注的影响.方法 回顾性连续纳入2017年9月至2021年10月因脑梗死于首都医科大学宣武医院神经内科或神经外科住院的ICAO患者386例,根据患者出现临床症状到入院治疗的时间间隔,将其分为急性期组(≤4周)和慢性期组(>4周).联合应用颈动脉彩色多普勒超声与经颅彩色多普勒超声对两组患者颅内血流动力学和侧支循环类型进行检测,同时应用血管造影检查侧支循环的开放情况,并对超声检查与血管造影的结果进行一致性检验.收集两组患者性别、年龄、身高、体质量、脑血管病危险因素(高血压病、糖尿病、高脂血症、吸烟、心房颤动、脑梗死、冠心病)及血管超声参数[管腔内径、收缩期峰值流速(PSV)、舒张期末流速(EDV)、侧支循环开放情况(侧支循环数量、开放类型)],并进行组间比较;对不同侧支(前交通动脉、后交通动脉、颈内-颈外动脉侧支)开放与否的血管超声参数进行比较.计算超声检查对不同侧支循环开放类型的敏感度、特异度、准确度.结果(1)386例ICAO患者中,急性期组165例,慢性期组221例.急性期组ICAO男性比例低于慢性期组,冠心病比例高于慢性期组,组间差异均有统计学意义(均P<0.05).年龄、高血压病、糖尿病、高脂血症、吸烟、心房颤动、脑梗死、体质量指数的差异均无统计学意义(均P>0.05).(2)超声检查显示,慢性期组后交通动脉开放率高于急性期组[52.5％(116/221)比40.0％(66/165),χ2=5.913,P=0.015].急性期组侧支循环开放数量主要为1～2支,占比分别为33.3％(55/165)、52.1％(86/165);而慢性期组侧支循环开放数量主要为1～3支,占比分别为24.0％(53/221)、53.4％(118/221)、19.0％(42/221),侧支循环数量分布的组间差异有统计学意义(χ2=11.394,P=0.010).(3)超声检查显示前交通动脉、后交通动脉、颈内-颈外侧支循环开放与血管造影检查结果的一致性检验Kappa值分别为0.544(P<0.01)、0.604(P<0.01)和0.656(P<0.01).超声检查前交通动脉的敏感度、特异度、诊断准确率分别为77.4％(236/305)、92.6％(75/81)、80.6％(311/386),超声检查后交通动脉的敏感度、特异度、诊断准确率分别为79.8％(142/178)、80.8％(168/208)、80.3％(310/386),超声检查颈内-颈外侧支循环的敏感度、特异度、诊断准确率分别为97.6％(200/205)、66.9％(121/181)、83.2％(321/386).(4)386例ICAO患者中,前交通动脉开放者患侧大脑中动脉PSV、EDV均高于未开放者,二者差异均有统计学意义[PSV:63.00(48.00,83.00)cm/s比50.50(40.00,69.50)cm/s,Z=-4.955;EDV:35.00(27.75,46.25)cm/s比29.00(23.00,35.75)cm/s,Z=-4.804;均P<0.01];前交通动脉开放者患侧大脑中动脉搏动指数与未开放者的差异无统计学意义(P>0.05);后交通动脉开放者患侧大脑中动脉PSV、EDV、搏动指数与未开放者的差异均无统计学意义(均P>0.05);颈内-颈外动脉侧支开放者患侧大脑中动脉PSV、EDV、搏动指数与未开放者的差异均无统计学意义(均P>0.05).结论 急性期与慢性期ICAO患者侧支循环的开放类型和数量存在差异性,超声检查与血管造影对侧支循环的检查结果的一致性较好,前交通动脉的开放对于ICAO患者颅内灌注的影响最大.

随着临床医学的发展及治疗手段的进步,对颈内动脉闭塞的影像学特征评估提出了更高的要求.影像学技术对于颈内动脉闭塞病变的精准评估,不仅要求对闭塞程度、部位及血管形态学等进行分类,而且要根据闭塞管腔的结构特征进行细化分类.影像学分类方法不同,为临床诊疗提供的客观信息则不同,相应的治疗方式也不同.因此,作者对与治疗方式相关的颈内动脉闭塞的影像学分类研究进行综述,为更加个体化治疗方式的选择提供参考.

The purpose of this study was to explore the relationship between plaque characteristics and re-occlu-sion after surgical treatment of internal carotid artery occlusion (ICAO). From January 2015 to January 2021, 177 patients with ICAO underwent surgery. Eighty-five cases were included in the study, and in 13 of them, re occlusion occurred within 6 mo after surgery treatment (13/85, 15.85%). The calcification at the base of the plaque was longer in the re-occlusion group than in the non -occlusion group (10.70 +/- 4.22 mm vs. 7.15 +/- 1.41 mm, p = 0.001). Multivariate regression analysis revealed that the length of calcification at the base of the plaque was an independent risk factor for postoperative re -occlusion (odds ratio [OR]: 1.414, 95% confidence interval [CI]: 1.078-1.855, p = 0.012). The cutoff value for the length of calcification at the base of the plaque predicting re occlusion after ICAO was 8.5 mm (95% CI: 0.700-0.962, p = 0.001). The area under the receiver operating characteristic curve was 0.831. Sensitivity and specificity were 70% and 80.9%, respectively. These results indicate that pre -operative ultrasound examination of the length of calcification at the base of the plaque could predict re occlusion after surgical treatment of ICAO. (C) 2021 World Federation for Ultrasound in Medicine & Biology. All rights reserved.

1951年,Fisher[1]首次报道了通过血运重建术对颈内动脉闭塞(internal carotid artery occlusion,ICAO)患者进行治疗的病例.随着临床脑卒中防治工作的开展,近些年国内外针对ICAO的超声评估,特别是对血运重建术的评估越来越受到临床的关注[2-4].对ICAO病变部位和病变特点进行准确评估能够帮助临床医师选择适宜的血运重建治疗方法,降低ICAO相关的脑卒中发生率[2].因此,超声影像学检查对于ICAO评估具有重要临床应用价值.2018年欧洲心脏病学会发布了有关指南[5],推荐颈动脉超声检查作为颈动脉疾病评估的首选方法,不同超声技术能够在ICAO的病因、病变程度、围手术期评估等方面为临床提供重要客观信息.本文对超声在ICAO评估中的临床应用及进展情况作一综述.