单侧颈内动脉狭窄或闭塞患者的侧枝循环与脑缺血的关系探讨

Approach to the collateral flow and ischemic brain lesions in patients with unilateral internal carotid artery stenosis or occlusion

目的:探讨单侧颈内动脉狭窄或闭塞患者侧枝循环代偿与脑缺血的关系。方法:将22例单侧颈内动脉狭窄或闭塞患者根据血管受累程度及有无侧枝代偿分为有侧枝代偿颈内动脉狭窄组和颈内动脉闭塞组及无侧枝代偿颈内动脉狭窄组三组,分别对三组患者的脑血流灌注显像结果进行对比分析。结果:13例单侧颈内动脉狭窄患者中6例有侧枝代偿,7例无侧枝代偿。9例单侧颈内动脉闭塞患者均有侧枝代偿。当颈内动脉狭窄或闭塞时,侧枝代偿常见于脑灌注损伤较重的患者,三组患者比较,患侧额、颞、顶叶皮层的血流灌注有显著性差异(t=-2.613,P=0.020;t=-2.489,P=0.030;t=-2.737,P=0.016),而枕叶、基底节及丘脑的血流灌注无明显差异(P>0.05)。结论:脑灌注损伤与血管狭窄程度及侧枝代偿有关,尽管脑血管造影检查与脑血流灌注显像结果间不能直接对比,但联合应用两种方法可对脑缺血有一个全面认识。

Objective：To approach the collateral flow and ischemic brain lesions in patients with unilateral internal carotid artery stenosis or occlusion.Methods：22 patients with unilateral internal carotid artery stenosis or occlusion were divided into three groups（unilateral internal carotid artery stenosis with collateral flow,unilateral internal carotid artery occlusion with collateral flow and unilateral internal carotid artery stenosis without collateral flow） according to collateral circulation and the severity of stenosis of the blood vessel.The result of the three groups in cerebral blood flow perfusion imaging were compared.Results：Of 13 cases,six patients with unilateral internal carotid artery stenosis and nine patients with unilateral internal carotid artery occlusion collaterals appeared.In other nine patients with unilateral internal carotid artery stenosis,collaterals can not be seen.Patients with unilateral internal carotid artery stenosis or occlusion with collateral flow demonstrated severe ischemic brain lesions compared without collateral flow.In the frontal,temporal and parietal area, the cerebral blood flow perfusion were significant different（t=-2.613,P=0.020;t=-2.489,P=0.030;t=-2.737,P=0.016）.In occipital area,basal ganglia and thalamus,they showed no significant different（P〉0.05）.Conclusion：In the individual patient,cerebral blood flow perfusion depends not only on the degree of stenosis but also on the existence of collateral pathways.Although cerebral blood perfusion imaging cannot be directly compared with digital subtraction angiography（DSA）,it would promote our understanding of the cerebral lesions considerably by combining angiographic information with perfusion data.