脑血管造影在颈动脉切除术中的应用初探

The study on the use of cerebral angiography in carotidectomy

目的 探讨脑血管造影对颈动脉切除术前大脑半球侧枝循环代偿预测的意义和大脑半球侧枝循环代偿的途径。方法 并用 Matas实验和脑血管造影做术前大脑半球侧枝循环代偿的预测。脑血管造影的方法是 :在颈部指压阻断患侧颈总动脉分别做椎动脉造影和对侧颈总动脉造影 ,观察患侧颈内动脉系统脑血管显影情况 ,并完成了三例不进行血管重建的颈动脉分歧部切除术。结果 使用该脑血管造影法可显示一侧颈总动脉阻断后该侧大脑半球代偿供血情况、供血途径和脑底动脉环相关部分的发育情况。三例术后均无闭塞性脑血管并发症发生。结论 该预测方法可靠、易行。在颈部阻断一侧颈动脉后 ,该侧大脑半球代偿供血主要通过脑底动脉环。具体代偿途径有三种 :1经前交通动脉 ;2经后交通动脉 ;

Objective To evaluate the significance of cerebral angiography in predicting the degree of cerebral blood circulation compensation before carotidectomy, and to observe its cllateral circulation.MethodsWe used both method of Matas test and cerebral angiography simultaneously before carotidectomy. That is: While occluding the common cervical artery of the ill side by finger pressing, the vertibral angiography and the contralateral cervical artery angiography were performed respectively. The image of the internal cirvical artery and its branches at the ill side was observed to predict the results of postperative cerebral blood circulation compensation before carotidectomy.Results The carotidectomy without vessel reconstruction was performed by above method on three patients,and there was no cerebral ischemic complications in them. The superiorities of our method may predict results after carotidectomy, and may image the compensatory cerebral collateral circulation and the Willis circle.Conclusions In our experience, the predictive method is reliable and relatively esay. After a cervical artery has been occluded, the cerebral hemisphere receives compensatory blood supply mainly through the Willis circle. The specific ways are following:①by the arteria communicans anterior,②by the arteria communicans anterior and the arteria communicans posterior,③by the arteria communicans postereor.