症状性急性颈内动脉不同部位闭塞侧支循环的临床研究

The clinical study of the collateral circulation about internal carotid artery different segment occlusion with acute clinical symptoms

目的研究颈内动脉不同部位闭塞后侧支循环的特征及临床和影像表现。方法用DSA研究颈内动脉急性闭塞后侧支的形成。选择DSA确诊的颈内动脉闭塞者48例,颈内动脉颈段闭塞28例,颈内动脉脑段闭塞20例。对比两组病例侧支方式及临床和影像表现。用NIHSSS评价发病7d时神经功能状况。头部CT/MRI显示的梗死面积用(A·B·C)/2计算。结果颈内动脉颈段闭塞组前交通动脉出现率和后交通动脉出现率及眼动脉出现率,开放侧支途径≥2条,高于颈内动脉脑段闭塞组(P<0.05)。软脑膜吻合支出现率在两组间无统计学差异。颈内动脉颈段闭塞组7d时NIHSSS≤8分的患者比颈内动脉脑段闭塞组多(P<0.05),梗死面积小(P<0.05)。结论颈内动脉不同部位闭塞的侧支方式不同,脑内侧支的多少和范围决定了梗死的大小和全面的诊断。

Objective To investigate the characterization of the collateral circulation and clinical and imaging data after internal carotid artery different segment occlusion. Methods All the 48 patients were with internal carotid artery occlusion by digital subtraction angiography diagnosing. 28 patients showed internal carotid artery cervical segment occlusion and the other 20 patients,internal carotid artery cerebral segment occlusion. Collateral circulation and clinical and imaging of the two groups was compared and their function with National Institutes of Health Stroke Scale score（NIHSSS） and the infarction size（cm^2） was estimated by（A · B · C）/2. Results In the internal carotid artery cervical segment occlusion groups, the presence rate of anterior communicating artery （ACoA） ,posterior communicating artery（PCoA）,ophthalmic artery（OphA）,which had 2 collateral pathways were higher than that of internal carotid artery cerebral segment occlusion group significantly （P〈 0.05）. The presence rate of loptomeningeal anastomoses （LMA） weren＇t significantly different between the two group （P〉0.05）. In the internal carotid artery cervical segment occlusion groups,the patients whose NIHSSS≤8 on the 7th day were more and the infarction size was smaller than those in internal carotid artery cerebral segment occlusion （P〈0. 05）. Conclusion It indicates that the collateral circulation is different when the internal carotid artery different segment occlusion occured. The collateral pathways decide the infarction size and the integrative diagnosis.