脑梗死患者脑血管病变及侧支循环状态的研究

Study of abnormal arteries and collateral circulations condition in patients with cerebral infarction

目的探讨脑梗死患者的责任病变血管及侧支循环主要方式。方法对110例脑梗死患者行牛津郡社区卒中项目(OCSP)分型,进行全脑数字减影血管造影(DSA)检查,判定梗死的责任血管、侧支循环是否存在及方式。结果各型患者,病变血管共137条,其中颈内动脉(ICA)54条(39.4%)、锁骨下-椎动脉(SUB-VA)42条(30.7%)、大脑中动脉(MCA)29条(21.2%)、颈总动脉(CCA)和基底动脉(BA)各4条(各2.9%)、无名动脉2条(1.5%)、大脑前动脉(ACA)和大脑后动脉(PCA)各1条(各0.7%);责任血管ICA49条(44.5%)、MCA27条(24.5%)、SUB-VA19条(17.3%)及CCA3条(2.7%)、IA2条(1.8%),余3支血管各1条(均占0.9%)。7例(6.4%)未发现异常。经软脑膜支吻合代偿59例,Willis环代偿49例,来自各种颅外代偿计27例,两种及以上方式联合代偿19例,罕见代偿3例,未发现代偿6例。结论脑动脉病变最多位于ICA、SUB-VA主干,其次位于MCA;前循环病变较后循环病变具有更高的梗死发生率。侧支循环代偿以Willis环最充分,软脑膜支吻合最常见;脑梗死的类型和预后受血管病变和侧支循环状态的综合影响。

Objective To investigate the affected vessels of patients with cerebral infaction and discuss the relationship between cerebralinfarction and abnormalarteries and collateralcirculation patterns. Methods Analyzing the digital subtraction angiography （DSA）results of 110 cases with cerebral infarction （ according to OCSP classification） , the abnormal duty arteries wereidentified and collateral circulations were estimated. Results Among 110 cases, abnormal arteries were 137, and theywere 54 internal carotid arteries （ICA）, 42 subclavicle-vertebral arteties （SUB-VA）, 29 middle cerebralarteries （MCA）, 4 common carotid arteries（CCA）, 4 basilar arteries （ BA）, 2 innominate arteries （ IA）, 1anterior cerebral artery （ACA） and 1posterior cerebral artery （PCA）. Duty arteries included 49 ICA （44.5%） ,27 MCA （24.5%） , 19 SUB-VA （ 17.3% ） ,,3 CCA （2.7%）,2IA （1.8%） and 3 other arteries （2.7%）. There were noabnormal duty arteries in 7 cases （ 6.4% ）. 59 cases were compensated by leptomeningeal anastomose and 49 cases by Willis circle.The collateral perfusion pattern of 27 cases was from external-cranium arteries. Rare pattern was seen in 3 cases. 19cases were compensated via 2 or more patterns. There was no compensation in 6 cases. Conclusions ICA, SUB-VAand MCA are the main involved arteries in the patients with cerebral infarction and anterior circulation ateries more easilycause cerebral infarction. Compensation by Willis circle is the most sufficient type but Leptomeningeal anastomose isthe most frequent. The type and prognosis of cerebral infarction are mainly affected by duty arteriesas well as collateral circulation condition.