关键词: 经颅多普勒; 大脑中动脉; 血管狭窄; 药物治疗; 经皮腔内血管支架成形术

Abstract:

Objective To retrospectively review and compare the hemodynamic effect of cerebral artery stenosis with single medical management or medical management plus percutaneous transluminal angioplasty and stenting (PTAS) by using transcranial Doppler ultrasound (TCD). Methods Selected patients whose middle cerebral artery (MCA) were in accordance with the requirement of digital subtraction angiography (DSA) to be moderate or severe stenosis were enrolled into study. There were 23 cases meeting the requirement, including 10 patients who received medical management plus PTAS and 13 patients who received single medical management. The hemodynamic effects of the two therapies were analyzed by using TCD. Results (1) The flow velocity of diseased vessels of the patients who only received medical treatment had no significant change in difference after an average follow-up time of 223.00 days. The flow velocity of stent vessels were increased and had significant difference (P =0.013) after an average follow-up time of 496.10 days. (2) The flow velocity of medical management plus PTAS group was slower than the single medical management group at the last follow-up time point which had significant difference. (3) The flow velocity of medical management plus PTAS group had a slight declining trend (P =0.042) at the first month follow-up and there were no significant differences. It increased quickly in the period of 1 to 3 months (P =0.002) and 6 to 12 months (P =0.020). Conclusion (1) From the view of hemodynamics, single medical management can effectively

prevent the degradation of stenosis. (2) Although the stenosis is aggravated after PTAS, the blood flow is still better than the single medical management group eventually. The reconstruction of PTAS has long-term effectiveness.

Key words: Transcranial Doppler ultrasound; Middle cerebral artery; Cerebral vascular stenosis; Medical therapy; Percutaneous transluminal angioplasty and stenting