Objective: To evaluate the value of color Doppler ultrasound and digital subtraction angiography (DSA) in evaluating the level of carotid bifurcation and the morphology of extracranial internal carotid artery in patients with atherosclerotic carotid stenosis. Methods: The carotid artery examination data of 186 patients with atherosclerotic carotid stenosis who underwent carotid DSA and color Doppler ultrasound in Shanghai Changzheng Hospital from July 2017 to June 2019 were retrospectively analyzed, including 154 males and 32 females, with ages ranging from 36 to 84 (66±8) years old. The correlation between the position of carotid bifurcation and the level of cervical spine, the distance from the position of carotid bifurcation to mandibular angle, the correlation of the level of bifurcation with the length of neck, and the incidence of carotid distortion were analyzed. Results: DSA showed that the most common position of carotid bifurcation was at C3 level on the left [37.3% (56/150)], and at C3-C4 level on the right [33.6% (42/125)], and the highest position was at C2 level on the left, and at C2-C3 levels on the right, while the lowest level on both sides was at C5 level. The incidence of high bifurcation of left carotid artery (C3 and above) was 46% (69/150), which was higher than that of right carotid artery [21.6% (27/125), P<0.001]. The incidence of high carotid bifurcation in men and women was 33.2% (76/229) and 43.5% (20/46), respectively, with no significant difference (P = 0.182). Carotid ultrasound showed that the distance between the left carotid bifurcation and the mandibular angle was (3.0±1.3) cm, which was shorter than that on the right [(3.4±1.2) cm] (P<0.001). The distance between carotid bifurcation and mandibular angle in men and women was (3.2±1.2) cm and (3.3±1.0) cm, respectively, with no significant difference (P = 0.093). There was no significant correlation between carotid bifurcation level and carotid length (right: r = 0.02, P = 0.091; left: r = 0.01, P = 0.927). The incidence of carotid artery distortion was 28.1% (9/32) in women and 15.6% (24/154) in men, with no significant difference (P = 0.091). The incidence of right carotid artery distortion in high bifurcation group was 59.3% (16/27), which was higher than that in non-high bifurcation group [3.1% (3/98)] (P<0.001). Likewise, the incidence of left carotid artery distortion in high bifurcation group was 30.4% (21/69), which was higher than that in non-high bifurcation group [2.5% (2/81)] (P<0.001). Conclusions: The bifurcation position of left carotid artery in patients with atherosclerotic carotid stenosis is higher than that of the right. Patients with high bifurcation of carotid artery are more likely to be complicated with carotid distortion. Preoperative color doppler ultrasound combined with DSA can evaluate the distortion of extracranial carotid artery, thereby providing reference for the selection of surgical methods.
目的： 探讨彩色多普勒超声（简称彩超）及数字减影血管造影（DSA）评估动脉粥样硬化性颈动脉狭窄患者颈动脉分叉水平及颅外段颈内动脉形态的价值。 方法： 回顾性分析2017年7月至2019年6月上海长征医院行颈动脉DSA和彩超检查的186例动脉粥样硬化性颈动脉狭窄患者的颈动脉检查数据，其中男154例，女32例，年龄36~84（66±8）岁。分析颈动脉分叉位置对应颈椎水平、颈动脉分叉位置至下颌角距离，以及分叉高低与颈长的相关性，统计颈动脉扭曲的发生率。 结果： DSA提示左侧颈动脉分叉水平最常位于C3水平，占37.3%（56/150），右侧最常位于C3~C4水平，占33.6%（42/125）。最高位于左侧C2、右侧C2~C3水平；双侧最低均位于C5水平。左侧颈动脉高分叉（C3及以上）发生率为46%（69/150），高于右侧的21.6%（27/125）（P<0.001）；男性、女性颈动脉高分叉发生率分别为33.2%（76/229）、43.5%（20/46），差异无统计学意义（P=0.182）。颈动脉彩超提示左侧颈动脉分叉与下颌角距离为（3.0±1.3）cm，小于右侧的（3.4±1.2）cm（P<0.001）；男性、女性颈动脉分叉与下颌角距离分别为（3.2±1. 2）、（3.3±1.0）cm，差异无统计学意义（P=0.093）。颈动脉分叉水平与颈长无相关性（右侧：r=0.02，P=0.091；左侧：r=0.01，P=0.927）。女性颈动脉扭曲发生率为28.1%（9/32），男性为15.6%（24/154），差异无统计学意义（P=0.091）。高分叉组右侧颈动脉扭曲发生率为59.3%（16/27），高于非高分叉组的3.1%（3/98）（P<0.001）；高分叉组左侧颈动脉扭曲发生率为30.4%（21/69），高于非高分叉组的2.5%（2/81）（P<0.001）。 结论： 动脉粥样硬化性颈动脉狭窄患者左侧颈动脉分叉位置高于右侧，颈动脉高分叉患者更容易合并颈动脉扭曲。术前彩超结合DSA检查能够评估颅外段颈动脉的扭曲程度，以期为手术方式的选择提供参考依据。.