缺血性脑血管病304例血管造影分析

Digital subtraction angiography in patients with ischemic cerebrovascular diseases: an analysis of 304 cases

目的分析缺血性脑血管病(ICVD)患者脑供血动脉狭窄或闭塞发生的特点。方法回顾性分析304例ICVD患者的DSA资料,其中短暂性脑缺血(TIA)188例,脑梗死116例,明确有无脑供血动脉的狭窄、狭窄的位置,判断责任血管,测量责任血管狭窄段长度及程度。结果304例ICVD患者中发现脑供血动脉狭窄或闭塞227例(74.7%),可判断责任血管193例(85.0%),其中单纯颅外血管病变104例(53.9%),单纯颅内血管病变70例(36.3%),颅内外串联病变19例(9.8%),TIA组的后循环颅外血管病变的发生率高于脑梗死组,脑梗死组的前循环颅内血管病变的发生率高于TIA组。两组责任血管狭窄的长度及严重程度均无明显差异(P>0.05)。结论重症缺血性脑血管病患者脑供血动脉狭窄或闭塞更多见,但责任血管狭窄的严重程度和长度与症状严重程度无关。

Objective To investigate the angiographic characteristics of cerebral arterial stenosis or occlusion in patients with ischemic cerebrovascular diseases （ICVD）. Methods Digital subtraction angiography （DSA） findings in 304 patients with ICVD were retrospectively analyzed. Of 304 cases, transient ischemic attack was seen in 188 cases （TIA group） and cerebral infarction in 116 cases （cerebral infarction group）. All the patients were examined by cerebral DSA. The angiographs were reviewed by experienced physicians. When any cerebral arterial stenosis or occlusion was demonstrated, its severity degree, location, guilty artery with its length were identified and measured. Results Of 304 cases with ICVD, cerebral arterial stenosis or occlusion was found in 227 cases （74.7%）, amidst which the guilty artery could be identified in 193 cases （85.0%）. The guilty arteries included purely extracranial artery （n= 104, 53.9% ）, purely intracranial artery（n = 70, 36.3%） and extra-together with intra-cranial artery（n= 19, 9.8%）. The occurrence of extracranial posterior circulation guilty artery was more frequently seen in TIA group than in cerebral infarction group, while the occurrence of intracranial anterior circulation guilty artery was more frequently seen in cerebral infarction group. No significant difference in the length and severity of guilty artery stenosis existed between TIA group and cerebral infarction group （P 〉 0.05）. Conclusion Cervicocranial artery stenosis or occlusion is more often seen in ICVD patients with severe symptoms. Both the severity and length of the guilty artery stenosis bear no relationship to the severity of the patient＇ s symptoms.