经颅多普勒超声（TCD）在颈动脉支架成形术后脑过度灌注综合征中的应用

摘要

Objective To explore the mechanism of cerebral hyper perfusion syndrome (CHS) after ca‐rotid artery stenting (CAS) and to study the evaluation of TCD in patients with CHS after CAS .Methods The clinical data of 3 cases with CHS in 43 patients performed CAS were analyzed retrospectively .Results 2 cases of carotid artery stenosis was extremely severe stenosis (> 90% ) ,1 cases was severe stenosis (70% ~90% ) .2 patients had headaches and nausea;1 case had local neurologie impairment and the level of consciousness was drowsiness .Transcranial Doppler (TCD)showed that the peak of cerebral blood flow was increased≥100% in middle cerebral artery .Conclusion The patients with severe and extremely severe of carotid artery stenosis ,inadequate of collateral circulation (not open of anterior communicating artery and/or posterior communicating artery ) and the blood flow of middle cerebral artery increased ≥ 100% after CAS may lead to CHS after CAS .%目的：探讨颈动脉支架术后脑过度灌注综合征（cerebral hyper perfusion syndrome ， CHS）的发生因素，并评估经颅多普勒超声（TCD）在颈动脉支架成形术后CHS中的作用。方法回顾分析了43例颈动脉支架成形术（CAS）后3例CHS的临床资料。结果狭窄程度：2例患者颈动脉狭窄为极重度狭窄（＞90％），1例患者为重度狭窄（70％～90％）。临床症状：2例患者有头痛并伴有恶心；1例表现为意识反应水平下降呈嗜睡状，出现局造性神经功能障碍。 T CD监测：T CD证实为支架侧大脑中动脉的血流增加≥100％。结论颈动脉狭窄为重度狭窄（70％～90％）或极重度狭窄（＞90％）；侧枝循环代偿不好（前交通或前、后交通动脉不开放）；术后1h T CD监测同侧大脑中动脉M 1段血流速度的变化为Ⅲ级增加（较基础值增加100％～150％）以上患者，术后发生CHS的可能性大。