The Evaluation Value Of Multiple Ultrasound Parameters On The Perioperative Vascular Structure And Hemodynamics Of Carotid Artery Stenting

Objective To explore the evaluation value of multiple ultrasound parameters on the vascular structure and hemodynamics during the perioperative period of carotid artery stenting.Methods From January 2019 to December 2021,a total of 83 patients with moderate-to-severe stenosis at the origin of the internal carotid artery(85stents were placed in total)who underwent carotid artery stent placement in Shenyang First People’s Hospital were retrospectively analyzed.The ultrasound parameters of carotid doppler ultrasonograhy were examined,and the preoperative and postoperative parameters were compared and analyzed to evaluate clinical diagnosis and curative effect.At the same time,using DSA as the golden standard,the results of CDU diagnosis of carotid artery stenosis and the results of DSA were evaluated for consistency.Results1.Vascular structural changes after CAS Inner diameter: A total of 85 stents were placed,and the inner diameter of each segment was measured after surgery,excluding the thickness of the stent.The inner diameter of the middle section of the stent(stenosis section)increased from(1.59±0.53)mm to(4.21±1.03)mm,P<0.01,there was a significant difference;the inner diameter of the proximal and distal sections of the stent decreased compared with those before operation,respectively(7.88±0.84)mmvs.(6.74±0.85)mm,(6.09±0.80)mmvs.(4.89±0.55)mm,P<0.01,th ere was a significant difference.Vascular dilatation ratio: the ratio of the residual inner diameter of the stenosis to the original inner diameter before surgery,and the ratio of the inner diameter of the middle section of the stent to the original inner diameter before surgery after surgery.It increased from 24.4±8.2 before operation to 65.0±18.6after operation,P<0.01,there was a significant difference.2.Hemodynamic changes after CAS The PSV of the proximal segment of the stent increased from(65±26)cm/s to(73±26)cm/s,and the RI decreased from 0.76±0.08 to 0.74±0.09.The P values were: P=0.068,P=0.266,all P>0.05,there was no significant difference.The PSV in the middle of the stent decreased from(373±143)cm/s to(91±34)cm/s,P<0.01,there was a significant difference.RI increased from0.63±0.16 to 0.70±0.08,P=0.014<0.05,the difference was statistically significant.The PSV of the distal segment of the stent decreased from(305±123)c m/s to(87±28)cm/s,P<0.01,there was a significant difference.RI increased from 0.61±0.18 to 0.66±0.09,but P=0.079>0.05,and there was no significan t difference.The PSV ratio was the PSV ratio of the stenosis and the distal common carotid artery before surgery,and the PSV ratio of the middle and proximal stent segments after surgery,which decreased from preoperative 6.95±4.59 to postoperative 1.36±0.75,P< 0.01,there was a significant difference.The RI ratio was the ratio of RI between the stenosis and the distal segment of the common carotid artery before surgery,and the ratio of RI between the middle and proximal stent segments after surgery,which increased from preoperative 0.85±0.22 to postoperative 0.94±0.15,P=0.044<0.05,the difference was statistically significant.3.Carotid artery ultrasound was used for the diagnosis of carotid artery stenosis In this study,a total of 149 carotid artery stenosis or occlusion were diagnosed by carotid ultrasound.Taking the diagnostic results of DSA as the golden standard,the diagnostic sensitivity and specificity of mild stenosis were91.67% and 98.49%;The diagnostic sensitivity and specificity of moderate stenosis were 90.91% and 95.65%;the diagnostic sensitivity and specificity of severe stenosis were 94.38% and 96.66%;the diagnostic sensitivity and specificity of occlusion were 84.62% and 99.26%.In the consistency analysis,compared CDU and DSA,Kappa value = 0.778> 0.75,P< 0.05,indicating that the two have a good consistency in the diagnosis of carotid artery stenosis.Conclusions1.The application of multiple ultrasound parameters to evaluate the changes of vascular structure and hemodynamics before and after CAS can help clinical screening of surgical cases and evaluation of postoperative effects.2.Both the PSV ratio and the RI ratio can be used as evaluation indicators for the improvement of stenosis after stenting,and the PSV ratio is more sensitive in comparison.3.Carotid ultrasound and DSA showed good consistency of carotid stenosis.Ultrasound can be used as the preferred method for screening and postoperative review of patients with carotid artery stenosis.