目的：利用经颅多普勒超声（transcranial Doppler，TCD）回顾性对比药物与支架成形术治疗症状性大脑中动脉（middle cerebral artery，MCA）狭窄的疗效。方法收集经数字减影血管造影术（digital subtraction angiography，DSA）证实一侧MCA存在中-重度狭窄的患者，包括接受经皮腔内血管支架成形术（percutaneous transluminal angioplasty and stenting， PTAS）联合药物治疗者10例及单纯药物治疗者13例，对两组患者治疗前后TCD显示的血流动力情况进行研究。结果（1）单纯药物治疗组平均随访223.00 d后病变血管血流速度改变较治疗前没有显著差异，而PTAS联合药物治疗组平均随访496.10 d后支架治疗血管血流速度较治疗后1周显著增快（P=0.013）；（2）最终随访时PTAS联合药物治疗组病变血管血流速度显著低于单纯药物治疗组（P=0.042）；（3） P TA S术后1个月病变血管血流速度下降，但无显著差异，术后3个月、12个月病变血管血流速度与前一时间段比较显著增快（P=0.002，P=0.020）。结论（1）单纯药物治疗可有效阻止血管狭窄的进展；（2）尽管PTAS术后血管发生了一定程度的狭窄，但最终其血流改善情况明显优于单纯药物治疗组，P TA S的血管重建作用远期有效。%Objective To retrospectively review and compare the hemodynamic effect of cerebral artery stenosis with single medical management or medical management plus percutaneous transluminal angioplasty and stenting (PTAS) by using transcranial Doppler ultrasound (TCD). Methods Selected patients whose middle cerebral artery (MCA) were in accordance with the requirement of digital subtraction angiography (DSA) to be moderate or severe stenosis were enrolled into study. There were 23 cases meeting the requirement, including 10 patients who received medical management plus PTAS and 13 patients who received single medical management. The hemodynamic effects of the two therapies were analyzed by using TCD. Results (1) The flow velocity of diseased vessels of the patients who only received medical treatment had no signiifcant change in difference after an average follow-up time of 223.00 days. The lfow velocity of stent vessels were increased and had signiifcant difference (P=0.013) after an average follow-up time of 496.10 days. (2) The lfow velocity of medical management plus PTAS group was slower than the single medical management group at the last follow-up time point which had signiifcant difference. (3) The lfow velocity of medical management plus PTAS group had a slight declining trend (P=0.042) at the ifrst month follow-up and there were no signiifcant differences. It increased quickly in the period of 1 to 3 months (P=0.002) and 6 to 12 months (P=0.020). Conclusion (1) From the view of hemodynamics, single medical management can effectively prevent the degradation of stenosis. (2) Although the stenosis is aggravated after PTAS, the blood flow is still better than the single medical management group eventually. The reconstruction of PTAS has long-term effectiveness.
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