颅外段颈内动脉重度狭窄或闭塞脑梗死解剖模式及与侧支循环的关系

Lesion pattern and collateral circulation in patients with cerebral infarction caused tracranial carotid artery W

目的 研究颈内动脉（ICA）颅外段重度狭窄或闭塞的脑梗死解剖特点,并探讨Ⅰ级侧支循环与脑梗死类型的关系.方法 选取症状性ICA起始段动脉粥样硬化性重度狭窄患者20例（重度狭窄组）及闭塞患者22例（闭塞组）,比较两组患者Ⅰ级侧支循环代偿情况、脑梗死发生情况,分析Ⅰ级侧支循环代偿与脑梗死类型的关系.结果 重度狭窄组PCoA开放患者明显多于闭塞组,ACoA＋PCoA开放患者明显少于闭塞组,差异均有统计学意义（均P＜0.05）;两组患者脑梗死类型均以多发性梗死为主,组间单发性脑梗死与多发性脑梗死发生率差异均无统计学意义（均P ＞0.05）;仅多发性梗死类型中重度狭窄组BZI＋PI梗死患者显著多于闭塞组（P＜0.01）;仅ACoA开放患者EBZ梗死发生率明显低于AcoA未开放患者（P＜0.05）,其余梗死类型均与侧支开放情况无关（P ＞0.05）.结论 多发性不连续梗死是ICA起始段动脉粥样硬化性重度狭窄或闭塞患者的主要梗死类型;前交通动脉的开放可减少外分水岭梗死的发生,但与其它梗死类型无关;其它侧支开放形式亦与梗死类型无关.

Objective To investigate the lesion pattern and collateral blood flow in patients with cerebral infarction caused by severe stenosis or occlusion of unilateral extracranial internal carotid artery （ICA）. Methods Forty two patients with acute ischemic stroke shown on diffusion-weighted imaging （DWI） and stenosis （ ≥70% ） or an occlusion of unilateral extracranial ICA confirmed by cerebral angiography, including 20 patients with severe stenosis and 22 with occlusion, were enrolled in the study within 3 days of onset. The ischemic lesions and primary collateral pathway were compared between two groups, and the relationship between ischemic lesions and primary collateral pathway was analyzed. Results Multiple ischemic lesions in severe stenosis or occlusion of extracranial ICA was 80%, the presence of border-zone infarct （ BZl ） concomitant partial infarct （ PI ） was higher in severe stenosis group than that in occlusion group（P〈0.01 ）. The presence of collateral flow via anterior communicating artery （ACoA） and posterior communicating artery （PCoA） was higher in occlusion group than that in severe stenosis group （P〈 0.05 ）, the prevalence of collateral flow via PcoA was higher in severe stenosis group than that in occlusion group（P〈0.05）. There was an increased prevalence of external border zone infarcts in the group without ACoA collateral flow compared with the group with ACoA collateral flow （P〈0.05）. No differences were found for any other ischemic lesions and collateral pathway. Conclusion An acute ischemic lesion in ICA severe stenosis or occlusive disease is mainly multiple. Collateral flow via the ACoA is associated with a reduction of the prevalence external border zone lesions, but not with any other type of ischemic lesion.