颅内外动脉狭窄的测量最详细

颅内外动脉狭窄的测量,检查手段,颈部：体检彩超CTMRDSA,头颅TCDCTAMRADSA,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MRMRA,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,DSA:,全面、多角度、着眼治疗,观测角度：,腔内显示：TCDCTAMRADSA,腔内外联合显示：彩超增强CT普通和高分辨,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 CarotidEndarterectomy 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;29:1389-1392,治疗策略：,自膨支架系统：球囊直径：远心段支架直径：近心段球扩支架系统：远心段、近心段相互结合必要时节段整合,颅内：,WASID方法，类似于颈动脉NASCET狭窄率=1-(Dstenosis/Dnormal) 100%,狭窄率=1-(Dstenosis/Dnormal) 100%,Dstenosis狭窄最重处的血管直径，Dnormal为近端的正常血管直径，分别有以下几种情况：1.对于大脑中动脉、椎动脉颅内段以及基底动脉，Dnormal定义为狭窄近端最宽的，无弯曲的正常动脉管径直径。2.如果近端血管有病变（如大脑中动脉起始段狭窄），那么就定义为狭窄远端最宽的无弯曲的正常动脉直径3.如果整个颅内动脉都有病变，就选择其主要供血动脉最远端的无弯曲的正常管径。如：整个基底动脉病变，Dnormal定义为其优势侧椎动脉最远端的无弯曲正常管径直径；整个大脑中动脉病变，定义为颈动脉床突上段最远端的无弯曲正常管径的直径；整个颅内椎动脉病变，定义为颅外椎动脉最远端无弯曲的正常管径直径。,另外，对于海绵窦前段、海绵窦段、海绵窦后段的颈动脉狭窄，Dnormal定义为颈动脉岩段最宽