单侧颈内动脉重度狭窄患者颅内侧支循环与急性缺血性脑血管病的相关性

Correlation of the intracranial collateral circulation and acute ischemic cerebrovascular disease in patients with unilateral internal carotid artery severe stenosis

目的探讨单侧颈内动脉(ICA)重度狭窄患者颅内侧支循环与急性缺血性脑血管病的关系。方法选取北京安贞医院2010年2月至2013年12月收治的单侧ICA起始部狭窄≥70%的患者39例为研究对象,其中有急性缺血性脑血管病者18例(症状组),无急性缺血性脑血管病者21例(无症状组),观察2组患者Willis环、侧支血管管径情况,分析单侧ICA重度狭窄患者急性缺血性脑血管病与侧支循环的关系。结果症状组患者高血压发病率显著高于无症状组,ICA狭窄程度大于无症状组(P<0.05)。症状组患者侧支血管代偿功能显著低于无症状组(P<0.05)。症状组患者Willis环前环完整率为72.2%(13/18),后环完整率为61.1%(11/18);无症状组患者前环完整率为95.2%(20/21),后环完整率为90.5%(19/21);症状组患者Willis环前、后环完整率显著低于无症状组(P<0.05)。症状组患者前、后环变异率分别为27.8%(5/18)和38.9%(7/18),无症状组患者前、后环变异率分别为4.8%(1/21)和9.5%(2/21),症状组患者Willis环前、后环变异率显著高于无症状组(P<0.05)。症状组患者前交通动脉管径显著小于无症状组(P<0.05),2组患者后交通动脉管径比较差异无统计学意义(P>0.05)。结论 Willis环的侧支代偿能力与Willis环变异与否及前、后交通动脉管径有关;Willis环代偿功能差是ICA重度狭窄患者发生急性缺血性脑血管病的主要因素。

Objective To study the relationship between the intracranial collateral circulation and acute ischemic cere- brovascular disease in patients with unilateral internal carotid artery （ ICA ） severe stenosis. Methods Thirty-nine patients with unilateral ICA stenosis（ ≥70% ） were selected in Beijing Anzhen Hospital from February 2010 to December 2013 as the subject. Among the patients, 18 patients with acute ischemic cerebrovascular disease as the symptom group ,21 patients without acute ischemic cerebrovascular disease as the symptomless group. Willis circle and collateral vessels diameter of the patients were observed in the two groups. The relationship between the intracrania] collateral circulation and acute ischemic cerehrovas- cular disease was analyzed in patients with unilateral ICA severe stenosis. Results The incidence rate of hypertension in symptom group was significantly higher than that in symptomless group （ P 〈 0.05 ）. The degree of ICA stenosis in symptom group was significantly more than that in symptomless group （ P 〈 0.05 ）. The compensatory function of collateral vessels in symptom group was significantly lower than that in symptomless group （P 〈 0.05 ）. The integrity rates of anterior ring and pos- terior ring of Willis circle in symptom group were 72.2% （ 13/18 ） and 61.1% （ 11/18 ）. The integrity rates of anterior ring and posterior ring of Willis circle in symptomless group were 95.2% （20/21） and 90.5% （ 19/21 ）. The integrity rates of anterior ring and posterior ring of Willis circle in symptom group were significantly lower than those in symptomless group（ P 〈 0.05 ）. The aberration rates of anterior ring and posterior ring in symptom group were 27.8 % （5/18） and 38.9% （7/18）. The aberra- tion rates of anterior ring and posterior ring in symptomless group were 4.8% （ 1/21 ） and 9.5% （2/21）. The aberration rates of anterior ring and posterior ring in symptom group were significantly higher than those in symptomless group（ P 〈 0.05 ）. The diameter of anterior communicating artery in symptom group was significantly less than that in symptomless group（ P 〈 0.05 ）.There was no significant difference in the diameter of posterior communicating artery between the two groups（ P 〉 0.05 ）. Con- clusions The compensatory function of Willis ring is related to tile aberration of Willis ring and the diameter of anterior com- municating artery and posterior communicating artery. The compensatory hypofrontality of Willis ring is the main factor for acute ischemic cerebrovascular disease in patients with unilateral ICA severe stenosis.