头颈动脉狭窄的测量.pptVIP

头颈部动脉狭窄的测量 检查手段 颈部： 体检 彩超 CT ＭＲ DSA 头颅 ＴＣＤ ＣＴＡ MRA DSA 体检： 触诊： 听诊： 超声： 彩色超声： 经颅多普勒超声： CT:  最大密度投影 表面重建 减影重建 曲面重建 断面观察 多种成像结合原始断层综合分析。 MR: MRI 高分辨MR MRA 1.容易夸大病变，假阳性。 2.不受钙化、无辐射、肾功要求低 3.增强MRA更准确 颈动脉狭窄测量 1： (1-md/C) 100% 2： (1-md/B) 100% 3： (1-md/A) 100% 1. North American Symptomatic Carotid Endarterectomy Trial (NASCET) 2. MRC European Carotid Surgery Trial(ECST) 3. Common carotid method（CC） NASCET North American Symptomatic Carotid Endarterectomy Trial, Methods, Patient Characteristics, and Progress ——North American Symptomatic Carotid Endarterectomy Trial (NASCET) Steering Committee，Stroke 1991;22;711-720 目的：评价症状性颈动脉狭窄的内膜剥脱术的效果 结论：对于症状性颈动脉狭窄的病人，狭窄程度在50-99%也是有效的 CSI 1995年，又有人提出了另一种测量方法，即颈动脉狭窄指数（Carotid Stenosis Index ，CSI），也是以颈总动脉为分母，并与NASCET和ECST进行比较。——C.F. Bladin, A.V. Alexandrov, et al. Carotid Stenosis Index，A New Method of Measuring Internal Carotid Artery Stenosis. Stroke. 1995;26:230-234 Figure 1. Angiogram shows anatomic sites of measurement in the carotid artery for calculating percent stenosis for the North American Symptomatic Carotid Endarterectomy Trial (NASCET), European Carotid Surgery Trial (ECST), and Carotid Stenosis Index (CSI) methods. D indicates diameter of internal carotid artery (ICA) stenosis; N, normal ICA diameter used in each method. Note that for CSI the common carotid artery value of N is multiplied by 1.2 to give the predicted outline of the proximal ICA. 椎动脉： 狭窄严重程度=（1-A/V）100%，A=最狭窄处的残余管径，V=病变远端的管壁大致正常的管径，类似于NASCET中的颈动脉狭窄的测量方法。 (the CAVATAS Investigators. Long-Term Outcome After Angioplasty and Stenting for Symptomatic Vertebral Artery Stenosis Compared With Medical Treatment in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS)，A Randomized Trial. Stroke. 2007;38:1526-1530) The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group. Prognosis of Patients With Symptomatic Vertebral or Basilar Artery Stenosis. Stroke. 1998