內頸動脈狹窄經支架置入術前與術後在電腦斷層上之成效評估

Evaluation of Computed Tomography Outcomes Before and After Stenting of Internal Carotid Artery Stenosis

簡宏哲(Hung-Che Chien) ； 黃姍姒(Shan-Su Hung) ； 張建法(Chien-Fa Chang) ； 張豐基(Feng-Chi Chang)

《臺灣醫事放射期刊》 10卷1期 (2022/07) Pp. 54-62

https://doi.org/10.6717/JTMRT.202207_10(1).0008

摘要

據統計顯示，台灣腦中風多年來位居十大死因的第2-4位，在每年缺血性腦中風的病人之中，與頸動脈狹窄相關的中風占了10～20%。頸動脈狹窄病變的成因包括粥狀硬化斑塊沉積、動脈內膜剝離、頭頸部惡性腫瘤壓迫及接受放射治療所造成的頸動脈纖維化。近年來針對頸動脈狹窄的治療方法多為頸動脈成型術併支架置放（Carotid artery angioplasty , with or without stenting , CAS），治療後需要定期追蹤，以及早防範頸動脈再狹窄化的可能性。本研究利用電腦斷層動脈血管攝影術，評估頸動脈狹窄患者在經支架置入術前與術後頸動脈狹窄處直徑變化、血流通透性等，測得相關數值來比較治療前後差異性。本研究以回溯性方式收取2018年二月至2022年三月進行頭頸部電腦斷層動脈血管攝影掃描共40位病患術前與術後的影像，並針對病患患側頸動脈的動脈相（arterial phase）進行Curved-MPR（Curved-Multiplanar Reconstruction）的繪製。繪製完成的Curved-MPR影像皆送至Siemens Healthineers Syngo.via影像工作站進行分析。首先使用工作站軟體測量每一位患者患側頸動脈術前最為狹窄的位置，針對此位置測量術前與術後的血管直徑（包含橫切面的左右徑與上下徑）、血管橫切面積、血管內的HU（Hounsfield Unit）值進行統計分析。統計結果顯示，治療前的平均血管橫切面左右徑直徑為0.368 cm、平均橫切面上下徑直徑為0.358 cm、平均截面積為0.124 cm^2、平均HU值為319.8 HU；支架治療術後平均血管橫切面左右徑直徑為0.412 cm、平均血管橫切面上下徑直徑為0.419 cm、平均截面積為0.163 cm^2、平均HU值為499.4 HU。三項項目其P值皆＜0.05，在統計學上具有顯著性差異。因此，內頸動脈狹窄患者經支架置入術後在電腦斷層影像上的治療成效具有顯著的改善，使用電腦斷層評估也具備一定的參考價值。

關鍵字

中風 ； 頸動脈狹窄 ； 電腦斷層 ； 支架置入術

並列摘要

Statistics show that Taiwan's cerebral apoplexy has ranked 2-4 among the top ten causes of death for many years. Among the patients with ischemic stroke every year, strokes related to carotid artery stenosis account for 10-20%. The causes of carotid stenosis include atherosclerotic plaque deposition, endarterial dissection, compression of head and neck malignancies, and carotid fibrosis caused by radiation therapy. In recent years, most of the treatment methods for carotid artery stenosis have been carotid artery angioplasty, with or without stenting (CAS). After treatment, regular follow-up is required to evaluate the possibility of carotid artery restenosis. In this study, computed tomography angiography is used to measure the diameter and blood permeability of carotid artery stenosis before and after stenting to evaluate the differences before and after treatment. First, we retrospectively collected preoperative and postoperative images of a total of 40 patients undergoing head and neck computed tomography angiography from February 2018 to March 2022 and analyzed the arterial phase of the affected carotid artery to draw Curved-MPR (Curved-Multiplanar Reconstruction). Next, the completed Curved-MPR images were sent to Siemens Healthineers Syngo.via imaging workstation for analysis. We used the workstation software to locate the most stenotic position of the carotid artery on the affected side of each patient before surgery and then measure the preoperative and postoperative blood vessel diameters, the cross-sectional area of the blood vessels, and the HU (Hounsfield Unit). All these values went through statistical analysis. The results show that: before the treatment, the average transverse section diameter of the blood vessel is 0.368cm, the average vertical diameter is 0.358cm, the average cross-sectional area is 0.124 cm2, and the average HU value is 319.8 HU. After the treatment, the average transverse section diameter of the blood vessel is 0.412 cm, the average vertical diameter is 0.419 cm, the average cross-sectional area is 0.163 cm2, and the average HU value is 499.4 HU. The P values of the three items are all ＜0.05, which is statistically significant. Therefore, our study demonstrated that computed tomography imaging could be a powerful way to evaluate the outcome for patients with internal carotid artery stenosis after stenting treatment.

並列關鍵字

stroke ； carotid artery stenosis ； computed tomography ； stenting