单侧颈内动脉起始段重度狭窄患者侧支循环状态的脑血管造影分析

Analysis of collateral circulations on digital subtracted angiography in patients with severe stenosis of proximal segment of unilateral internal carotid artery

目的探讨单侧颈内动脉起始段重度狭窄患者侧支循环状态的数字减影脑血管造影(DSA)表现。方法回顾性分析70例单侧颈内动脉起始段重度狭窄患者的DSA,判定单侧颈内动脉起始段重度狭窄后,侧支循环是否存在及存在的主要方式。结果单侧颈内动脉起始段狭窄患者侧支循环出现频度,前交通动脉58例(83%),后交通动脉18例(26%),大脑前、后交通动脉均显影11例(16%),眼动脉70例(100%),脉络膜前动脉37例(53%),脉络膜后动脉5例(7%),同侧大脑前、后动脉或中动脉之间吻合12例(17%),同侧大脑前、中动脉之间吻合14例(20%),椎动脉造影示软脑膜吻合支3例(4%),基底节区前组和后组异常血管网(MMD)血管9例(13%)。结论DSA检查发现单侧颈内动脉起始段重度狭窄患者均存在不同的侧支循环。通过准确分析病变侧侧支循环形成状态和脑血管代偿能力,制定个体化治疗方案。

Objective To characterize the DSA of collateral circulations in patients with severe stenosis of proximal segment of unilateral internal carotid artery （ICA）. Methods The DSA of 70 patients with stenosis of proxinal segment of unilateral ICA was investigated to confirm the patterns of collateral circulations. Results Anterior communicating artery （ACoA） was present in 58 cases（ 83%）, posterior communicating artery （PCoA） in 18 （ 26 % ）, anterior and posterior communicating arteries at same time in 11（16%）,ophthalmic artery in 70（100%）, anterior choroidal artery in 37（53%） and posterior choroidal artery in 5（7%）. Twelve（17%） patients had leptomeningeal anastomosis between ipsilateral anterior cerebral artery （ACA） and posterior cerebral artery or middle cerebral artery （MCA）,14（20%） patients had anastomosis between MCA and ACA. Vertebral artery imaging showed leptomeningeal anastomosis in 3 patients（4%）,and Moyamoya phenomenon was present in 9 patients（13%）. Conclusions Various patterns of collateral circulations （such as the Willis circle, ophthalmic artery, leptomeningeal anastomosis, anterior choroidal artery,etc） can be demonstrated by DSA in patients with severe stenosis of proximal segment of ICA. Individual treatment strategies can be made based on the patterns and compensatory capacity of the collateral circulations.