超声评价颈内动脉闭塞后颅内侧支循环开放类型对大脑中动脉血流速度和临床表现的影响

Ultrasound evaluation of the effects of collateral circulation patent types after internal carotid artery occlusion on the middle cerebral artery blood flow velocity and clinical manifestations

目的探讨颈内动脉闭塞(ICAO)患者颅内侧支循环的开放率和开放类型对患侧大脑中动脉(MCA)平均流速(MVMCA)下降率和临床表现的影响。方法回顾性分析151例经颈动脉彩色多普勒超声(CDFI)检测、DSA证实的ICAO患者的临床资料,根据患者头部CT、MRI及临床表现,分为脑梗死组(CI组)69例、短暂性脑缺血发作组(TIA组)40例和无症状组(Asy组)42例。通过经颅多普勒超声(TCD)检测双侧MCA的平均流速(MVMCA)及侧支循环的开放情况,将侧支循环开放分为前交通动脉(ACoA)、后交通动脉(PCoA)及颈内-外动脉(ICA-ECA)的开放,比较3组间患者颅内动脉侧支循环的开放率、开放类型、患侧MVMCA下降率的差异性。结果①3组间各侧支动脉开放率的差异均有统计学意义(χ2=42.297,P=0.000)。Asy组ACoA(51.7%,78/151)、PCoA(38.4%,58/151)及ACoA+PCoA+ICA-ECA(7.3%,11/151)开放率均高于TIA和CI组(P<0.001),ICA-ECA的开放率亦高于CI组(P<0.001);TIA组与CI组比较,除ICA-ECA为TIA组高于CI组外(P<0.001),其他侧支开放率的差异均无统计学意义。②3组间MVMCA下降率差异有统计学意义(F=174.249,P=0.000)。Asy组MVMCA下降率为(30±11)%,TIA组为(51±4)%,CI组为(65±7)%。AcoA+PCoA同时开放者,患侧MVMCA下降率最低(P=0.000)。结论一侧ICA闭塞后,侧支循环的开放程度与临床表现相关。ICAO患者的ACoA+PCoA同时开放可以降低患侧大脑中动脉平均血流速度的下降程度,具有相对较好的预后。

Objective To investigate the effects of collateral circulation patency and types on the reduction of ipsilateral mean velocity of the middle cerebral artery （ MVMCA ） and clinical prognosis in patients with internal carotid artery occlusion （ICAO）. Methods The clinical data of 151 patients with ICAO detected by color Doppler flow imaging （CDFI） and confirmed by digital subtraction angiography （DSA） were analyzes retrospective. According to brain CT, MRI and clinical manifestations of the patients, they were divided into cerebral infarction group （ CI group, n = 69 ） , transient ischemic attack group （ TIA group, n = 40） , and asymptomatic group （Asy group, n = 42）. The ipsilateral MVMcA and collateral circulation patency were recorded by transcranial Doppler （TCD）. The collateral circulation patencies were clas- sified into anterior communicating artery （ACoA）, posterior communicating artery （PCoA）, and external- internal carotid artery （ECA-ICA）. The differences of the patency, patent types and decrease rate of ipsi-lateral MVMCA were analyzed and compared. Results ①There were significant differences in all collateral circulation patencies among all the 3 groups （ χ2 = 42. 297, P = 0. 000 ）. The patencies of ACoA （51.7%,78/151）, PCoA （38.4%, 58/151） and ACoA＋PCoA （7.3%, 11/151） in the Asy group were higher than those in the TIA and CI groups （P 〈 0.001 ）. The patency of ICA-ECA was also higher than that in the CI group （ P 〈 0. 001 ）. In addition to ICA-ECA, there was no significant difference in all the patencies between the TIA and CI groups. In the ICA-ECA patency, the CI group was lower than the TIA group （P 〈0.001 ）. （~）There were significant differences in the decreased rate of MVMcA between each of the 3 groups （F=174.249;P=0.000）. The decreased rate in the Asy group was 30 ±11% and in the TIA group was 51±4%, and the decreased rate of MVMCA in the CI group was 65 ±7%. In patients with the AcoA ＋ PCoA patency at the same time, the decreased rate of ipsilateral MVMcA dropped to the lowest （P = 0.000）. Coneluslou After the ICA occlusion on one side, the degree of collateral circulation patency is associated with the clinical manifestations. The ACoA and PCoA patency at the same time of patients with ICAO may reduce the decrease rate of iosilateral MV and have a relativelv better nroanosis.