Efficacy evaluation of CT perfusion imaging for medical and endovascular treatment in patients with internal carotid arterial stenosis
10.3969/j.issn.1672-5921.2010.07.002
- Author:
Hong-Feng WEN
1
Author Information
1. Department of Neurology
- Publication Type:Journal Article
- Keywords:
Carotid stenosis;
Perfusion imaging;
Stents;
Tomography;
X-ray computed
- From:
Chinese Journal of Cerebrovascular Diseases
2010;7(7):344-349
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To investigate the CT perfusion (CTP) imaging for evaluation of hemodynamic changes in patients with internal carotid stenosis before and after the medication and stenting. Methods: Forty patients with severe unilateral internal carotid stenosis (ipsilateral stenosis > 70%, contralateral stenosis < 30%) were detected by CT angiography (CTA) and conformed by digital subtraction angiography (DSA), CTP imaging was performed at the same time. Twenty-two patients with good vascular compensation at the ischemic sites and with no significant delay in blood flow were treated with medication (aspirin 100 mg, clopidogrel 75 mg and atorvastatin 20 mg daily). CTA and CTP were performed again after one year. Stenting was performed in the other 18 patients without vascular compensation or inadequate compensation and significantly delayed in blood flow, and then they took anti-platelet aggregation and plaque stable drugs (the same as the medication group). The relative perfusion parameters including regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), regional mean transit time (rMTT), and regional time to peak (rTTP) in both groups (including the examination on admission and reexamination after one year) were compared. All the absolute perfusion parameters of the ipsilateral and contralateral sides in the operation group (including before the procedure, 7 days and one year after the procedure) were also compared. Results: Circled digit one All the relative perfusion parameters before medication and before operation were compared. In addition to rCBF (0.86 ± 0.18; 0.42 ± 0.26) and rCBV (1.02 ± 0.03; 1.15 ± 0.06), there were no significant difference in other parameters (P > 0.05). Circled digit two All the relative perfusion parameters after taking medicine for one year in the medication group and one year after the procedure in the operation group were compared. In addition to rCBF, there were significant differences in other parameters (P < 0.05). Circled digit three TTP and MTT were delayed on the ipsilateral sides before the procedure, and CBF were decreased to various degrees in 18 patients in the operation group, compared to the contralateral sides, there were significant difference. Seven days after the procedure, CTP imaging showed that CBF was improved significantly, and TTP and MTT were still delayed. In comparison with the ipsilateral and contralateral sides one year after the procedure in CTP imaging, there were no significant differences among TTP, MTT, CBF, and CBV. The comparative analysis of the absolute parameters at 3 time points were performed, and there were significant differences in the changes of TTP, MTT, and CBF on the ipsilateral sides (P < 0.05). Circled digit four After the medication group were followed up for 1 year, there were two new patients with TIA, and one of the two patients improved before the treatment. Eighteen patients in the operation group were followed up for one year after the procedure, and there were no new patients suffered TIA. Among the 16 patients with TIA before the procedure, 9 improved, and there were significant differences before and after the procedure (P < 0.05). Conclusion: CTP imaging can accurately reflect the medication and hemodynamic conditions of patients with internal carotid stenosis before and after stenting, According to the related parameters in combination with the clinical and DSA results, it has the guiding role for reasonable choice of surgical indications and objectively evaluate the efficacy and prognosis.
