彩色多普勒超声评价颈内-外动脉侧支循环对颈总动脉血流动力学的影响

The hemodynamic effects of internal-external collateral circulation for the common carotid artery

目的探讨颈内动脉(ICA)重度狭窄或闭塞时颈内-外动脉侧支循环(IEACC)是否开放对患侧颈总动脉(CCA)血流动力学的影响。方法选择临床及影像资料完整,单侧ICA颅外段狭窄70%～99%(74例)、闭塞(86例),且健侧ICA及双侧CCA正常或狭窄程度<50%的患者。按IEACC是否开放将患者分为ICA狭窄70%～99%IEACC开放组(42例)和IEACC未开放组(32例),闭塞IEACC开放组(43例)和IEACC未开放组(43例)。采用彩色多普勒超声测量CCA和颈外动脉(ECA)的收缩期峰值流速(PSV)、舒张末期流速(EDV)、平均流速(MV)、阻力指数(RI),计算CCA的血流量(BFV)。分别比较ICA狭窄70%～99%及闭塞时,IEACC是否开放对患侧CCA血流动力学的影响,分析ECA在IEACC开放后患侧、健侧血流动力学的变化特点。结果(1)ICA狭窄70%～99%组与闭塞组IEACC开放者患侧CCA的EDV、BFV高于IEACC未开放者,EDV分别为(15±5)cm/s、(12±5)cm/s(P=0.010)与(14±6)cm/s、(10±6)cm/s(P=0.002),BFV分别为(676±271)ml/min、(557±188)ml/min(P=0.036)与(606±218)ml/min、(488±180)ml/min(P=0.035),而PSV、MV、RI差异均无统计学意义;(2)ICA狭窄70%～99%组与闭塞组IEACC开放者比较,患侧CCA的PSV、EDV、MV、RI、BFV差异均无统计学意义;IEACC未开放患者比较,70%～99%组的EDV及BFV高于闭塞组,分别为(12±5)cm/s、(10±6)cm/s(P=0.014)与(557±188)ml/min、(488±180)ml/min(P=0.047);(3)ICA狭窄70%～99%组及闭塞组IEACC开放者患侧ECA的PSV、EDV、MV高于健侧,分别为(124±35)cm/s、(107±22)cm/s(P<0.001),(34±12)cm/s、(22±8)cm/s(P<0.001)与(64±18)cm/s、(50±11)cm/s(P<0.001);RI值患侧低于健侧,分别为0.72±0.07、0.79±0.07(P<0.001);IEACC未开放者患侧与健侧比较ECA各血流动力学参数无明显差异。结论IEACC开放与否影响颈总动脉血流动力学的变化。

Objective To evaluate the hemodynamic changes of common carotid artery （CCA） and external carotid artery （ECA） with unilateral high-degree stenosis or occlusion of the internal carotid artery （ICA） after internal-external artery collateral circulation （IEACC） opening. Methods A total of 160 patients with 70% -99% of stenosis or occlusion of ICA distal to the CCA were enrolled in this study. The peak systolic velocity （PSV）, end-diastolic velocity （EDV）, mean velocity （MV）, resistance index （RI） of CCA and ECA were detected by means of color duplex ultrasonography （CDU）. The blood flow volume （BFV） was calculated after examination. We analyzed the hemodynamic parameters in the CCA with highdegree stenosis and occlusion of ICA. The external carotid artery difference was compared between healthy and affected side after IEACC opening. Results （ 1 ） After IEACC opening, either EDV or BFV increased in 70% -99% of stenosis and occlusion group （ P 〈 0. 001 ）, while PSV ,MV,RI showed no difference. （2） There was no difference for the hemodynamic parameter between 70% -99% of stenosis group and occlusion group with IEACC opening. （3） If IEACC did not open, the EDV and BFV of CCA decreased in ICA occlusion group compared to ICA 70%-99% stenosis group. The EDV 〈 10 ±6 cm/s, BFV 〈 488 ± 180 ml/min of CCA indicated occlusion on the same side of ICA. （4） The PSV, EDV, MV of ECA increased and RI decreased in 70%-99% of stenosis and occlusion group （ P 〈 0. 001 ） after IEACC opening. We found PSV 〉 124 ± 35 cm/s, EDV 〉 34 ± 12 cm/s, MV 〉 64 ± 18 cm/s, RI 〈 0.79 ± 0.07 of ECA which indicated a IEACC opening on the same side of carotid. Conclusion Our results suggest that hemodynamic parameters of the CCA can be influenced by IEACC opening. The collateral circulation of intra and extra-cerebral blood flow will be helpful for improving the accuracy of ICA occlusion disease.