颈动脉重度狭窄患者侧支循环分级与临床结局的相关性

The correlation of collateral grading and clinical outcome in carotid severe stenosis.

目的应用数字减影血管造影（DSA）研究颈内动脉重度狭窄患者侧支循环开放途径和程度，并观察其对患者临床结局的影响。方法经全脑DSA检查证实存在颈内动脉重度狭窄（70％～99％）患者49例，评价其侧支循环开放的途径和程度。观察12个月后新发脑梗死、短暂脑缺血发作（TIA）或脑出血的发病情况。结果①49例患者，无侧支循环开放9例（18．4％，9／49），初级侧支循环开放39例（79．6％，39／49），次级侧支循环开放25例（51．0％，25／49）。开放途径与临床结局无明显相关。②49例患者侧支开放程度0级9例（18．4％，9／49），并发症发生率44．44％（4／9），1、2级15例（30．6％，15／49），并发症发生率50．66％（8／15），3、4级25例（51．O％，25／49），并发症发生率24．00％（6／25），3、4级患者缺血性脑血管病发生率显著高于0级和1、2级患者（Х^2值分别为4．856、3．242，P均〈0．05）。结论颈内动脉重度狭窄时，侧支循环代偿途径与临床结局无明显相关，侧支循环程度与临床结局显著相关。

Objective To research collateral pathways and collateral grading through digital subtract angiography（DSA） and their relation to clinical prognosis. Methods Collateral pathways and collateral grading of 49 cases suffered from severe internal carotid artery （ICA） stenosis （70% -99% ） were assessed through DSA. Incidence of stroke, TIA or cerebral hemorrhage were observed in the following 12 months. Results ①In all the subjects, no collateral pathway exist in 9 cases （18. 9% ）, and primary and secondary collateral pathways occurred in 39（79. 6% ） and 25（51.0% ） cases. Pathway is not related to clinical prognosis. ②There were 9 , 15 and 25 cases in 0 grade, 1 -2 grade and 3 -4 grade collateral circulation and the complication ratio is 44.4%, 50. 66% and 24. 00% respectively. Incidence of ischemic cerebrovascular disease is significantly higher in 3 - 4 grade patinets than those in 0 and 1 - 2 grade pation（ Х^2 = 4. 856, 3. 242 ; all P 〈 0. 05 ）. Conclusions Collateral levels but not pathway were correlated with clinical prognosis in patients with severe stenosis of internal carotid artery.