颈动脉严重狭窄或闭塞对颅内循环的影响

Hemodynamic changes of intracranial circulation in the patients with severe extracranial carotid stenosis

目的 分析严重的颅外段颈动脉狭窄或闭塞对颅内循环的影响。方法 采用彩色多普勒超声 (CDFI)筛查单侧严重颈动脉狭窄或闭塞的患者 ,用经颅多普勒超声 (TCD)评价颅内动脉的血流动力学变化。结果 ①严重颈动脉狭窄或闭塞病变同侧的大脑中动脉峰值流速和搏动指数均显著低于对侧 (P <0 .0 1)。②在各侧支循环开放组中 ,中风和TIA发病率分别为 :无交通支开放 (A组 ) 77.4% ;单支开放 (B组 ) 69.6% ;双支开放 (C组 ) 65 .4% ;三支开放 (D组 ) 46.4%。③前交通支的开放与中风发生呈负相关 (P =0 .0 0 9)。结论 严重的颅外段颈动脉狭窄或闭塞使同侧半球血流量下降 ,侧支循环建立。

Objective To study the impact of severe stenosis of the extracranial carotid on hemodynamics of intracranial circulation. Methods CDFI was used to examine the patients with unilateral severe stenosis or occlusion of the carotid artery. TCD was applied to evaluate intracrinial arteries. Results ①The velocity and PI of ipsilateral MCA were significantly lower than that of contralateral MCA. ②Collateralization establishment (ACoA, PCoA, OA):There were 31 individuals with non-collateralization (group A), 23 with one collateralization (group B), 52 with two collaterals (group C), and 28 with three collaterals (group D). The incidence of stroke and TIA were 77.4%, 69.6%, 65.4%, 46.4% respectively. ③The opening of ACoA was in negative relation with the occurrence of stroke ( P =0.009). Conclusion Severe carotid stenosis could decrease the blood flow of the ipsilateral hemisphere, and the collateralization could be established intracranially; the formation of collateralization had negative relation with the occurrence of stroke or TIA.