经颅彩色多普勒超声对颈内动脉闭塞患者颅内侧支循环及血供的研究

Study on intracranial arterial collateral pathways and hemodynamics in patients with internal carotid artery occlusion using transcranial color Doppler ultrasonography

目的探讨颈内动脉闭塞时颅内动脉侧支循环血流代偿的途径及血供状况。方法选择单侧颈内动脉闭塞患者29例,应用经颅彩色多普勒超声显像(TCCD)、能量多普勒(CDE)及超声造影检测双侧眼动脉(OA)及颅内动脉;分别根据患侧OA反向血流、患侧大脑前动脉(ACA)的A1段反向血流或压迫健侧颈总动脉(CCA)患侧大脑中动脉(MCA)血流速度降低、压迫患侧CCA同侧大脑后动脉(PCA)的P1段血流速度增高,判断OA、Willis环前交通动脉(ACoA)、Willis环后交通动脉(PCoA)侧支循环途径代偿。结果29例患者经TCCD和CDE检查OA均显示清楚,MCA、ACA、PCA完全显示16例(55.2%),另13例(44.8%)行超声造影后均能完全显示。经OA、ACoA、PCoA侧支循环代偿分别29例(100%)、24例(82.7%)、2例(6.8%)。患侧OA血流速度较健侧增高,搏动指数、阻力指数减小(P<0.05);而患侧MCA、ACA流速较健侧降低(P<0.05),搏动指数、阻力指数无明显变化(P>0.05)。结论TCCD、CDE、超声造影能实时观察颅内动脉侧支循环及血供,为脑血管检查的有效方法。

Objective To evaluate the intracranial arterial collateral blood flow pathways and the changes of hemodynamics. Methods A total of 29 patients with unilateral internal carotid artery occlusion were selected. In these cases, their ophthalmic arteries （OA） and cerebral arteries were observed using transcranial color Doppler ultrasonography （TCCD）, color Doppler energy imaging（CDE） and contrast- enhanced color Doppler ultrasonography. Collateral pathways through the ill-lateral OA, anterior and ill- lateral posterior communicating artery（ACoA and PCoA, respectively） were demonstrated by reversal of blood flow in the ipsilateral OA, reversal of blood flow in the ipsilateral A1 segment of the anterior cerebral artery（ACA） or decrease of blood flow velocity in ipsilateral middle cerebral arteries （MCA） during contralateral common carotid artery（CCA） compression and the increase of blood flow velocity in ipsilateral P1 segment of the posterior cerebral artery（PCA） during ipsilateral CCA compression, respectively. Results ①Among 29 cases, bilateral OA of 29 patients（100%） and bilateral MCA, ACA and PCA of 16 patients （55.2%） could be visualized by TCCD and CDE. The other 13 patients（44.8%） can be seen clearly only after contrast-enhanced color Doppler ultrasonography. ②There were intracranial arterial collateral blood flow pathways of 29 patients（100%） through OA, 24 patients（82.7%） ACoA and 2 patients （6.8%） PCoA, respectively. ③The blood flow velocity was higher in ill-lateral OA than in contralateral OA, but PI and RI lower（ P 〈0. 05）. On the contrary, the blood flow velocity was lower in ill-lateral MCA and ACA than in contralateral MCA and ACA, but PI and RI had no significant difference. Conclusions The intracranial arterial collateral blood flow pathways and the changes of hemodynamics can be evaluated realtimely by TCCD, CDE and contrast-enhanced color Doppler ultrasonography. They will be efficient means for examination of cerebral arteries.