经颅多普勒评估颈内动脉系统动脉闭塞患者的侧支循环代偿能力

Collateral Compensative Capacity Assessed by Transcranial Doppler in Patients with Artery Occlusion of Internal Carotid Artery System

目的探讨颈内动脉系统动脉闭塞患者的侧支循环代偿能力。方法对213例颈内动脉系统动脉闭塞患者,采用经颅多普勒技术检测颅内侧支循环通路。结果颈内动脉颅外段闭塞,经颅多普勒显示眼动脉侧支通路开放58%,前交通动脉侧支通路开放93%,后交通动脉侧支通路开放60%。颈内动脉远段闭塞,经颅多普勒显示眼动脉侧支通路开放15%,前交通动脉侧支通路开放51%,后交通动脉侧支通路开放61%。大脑中动脉主干闭塞患者均出现软脑膜吻合侧支循环,91%病侧大脑前动脉血流速度代偿性增快,9%病侧大脑后动脉血流速度代偿性增快。15例(7%)未发现侧支循环,108例(55%)1个侧支通路建立,79例(40%)2个侧支通路建立,11例(5%)3个侧支通路建立。结论经颅多普勒有助于了解颈内动脉系统动脉闭塞患者的侧支循环代偿能力,为评价治疗效果和预后提供了重要的客观依据。

Aim To assess collateral compensative capacity in patients with artery occlusion of internal carotid artery system, Methods In 213 patients with artery occlusion of internal carotid artery system, collateral circulation pathway was measured by transeranial doppler （TCD）, Results With extraeranial internal carotid artery occlusion, TCD showed ophthalmic artery collateral pathway （OA） in 58%, anterior communicating artery coUateral pathway （ACoA） in 93%, and posterior communicating artery collateral pathway （PCoA） in 60% of patients. With distal internal carotid artery occlusion, TCD shewed OA in 15 %, ACoA in 51%, and PCoA in 61% of patients. In all middle cerebral artery stem occlusion, TCD shewed leptomeningcal anastomoses collateral pathway, blood flow velocity compensative acceleration of the lesion side anterior cerebral artery in 91%, blood flow velocity compensative acceleration of the lesion side posterior cerebral artery in 9% of patients. Absent collateral flow was found in 15 patients （7%）. The study found 108 patients （55%） withl coUateral pathway, 79 patients （40%） with2 collateral pathway, and 11 patients （5 % ） with 3 collateral pathway. Conclusions TCD might further help to know the collateral compensative capacity of patients with artery occlusion of internal carotid artery system. It was suggested that TCD might be an important and objective index in evaluating the treatment effect and the prognosis.