影像学诊断颈内动脉重度狭窄或闭塞的Willis环侧支开放及脑梗死形式

Role of imaging in diagnosis of opening of Willis circle and IS forms in internal carotid artery severe stenosis or occlusion

目的探讨颈内动脉重度狭窄或闭塞的缺血性脑血管病患者Willis环侧支循环代偿及脑梗死形式。方法选择2012年3月~2014年3月天津医科大学总医院神经内科收治的颈内动脉重度狭窄或闭塞的缺血性脑血管病患者98例,其中新发脑梗死患者64例。头颅CT血管成像或磁共振血管成像显示,颅内外脑动脉狭窄情况及颅底动脉环开放形式。按颈内动脉狭窄或闭塞部位分为颅内组11例、颅外组40例及内外并存组47例,分析比较3组Willis环开放情况及脑梗死形式。结果内外并存组男性比例明显高于颅内组（91.49%vs 54.55%,P〈0.05）,糖尿病和吸烟是颅外颈内动脉重度狭窄或闭塞的独立危险因素（P=0.037,P=0.042）。3组Willis环各分型发生率比较,无统计学差异（P〉0.05）。颅外组皮质脑梗死较内外并存组增多（44.00%vs 13.64%,P〈0.05）;内外并存组分水岭脑梗死较颅外组增多（59.09%vs 28.00%,P〈0.05）。前交通动脉开放者颈内动脉分布区大面积脑梗死的发生较无开放者发生率低（4.00%vs 23.08%,P=0.048）。结论颈内动脉不同部位重度狭窄或闭塞Willis环开放形式无统计学差异,提示脑卒中发病有多种机制参与,前交通动脉开放可以降低大面积脑梗死的发生率。

Objective To study the collateral circulation compensation of Willis circle and forms of ischemic stroke in patients with ischemic cerebrovascular disease （ICD） due to internal carotid ar- tery severe stenosis or occlusion. Methods Ninety-eight patients with ICD due to severe internal carotid artery stenosis or occlusion admitted to our hospital from March 2012 to March 2014 were divided into intracranial ICD group （n =11）, extracranial ICD group （n = 40）, and intracranial ＋ extracranial ICD group （n=47） according to their CTA or MRA. The collateral branch opening of Willis circle and forms of ischemic stroke were analyzed in 3 groups. Results No significant difference in the incidence of colletral branch opening of Willis cicircle was found in 3 groups （P〉 0. 05）. The incidence of cortical ischemic stroke was significantly higher in extracranial ICD group than in intracranial＋extracranial ICD group （44.00% vs 13.64% ,P=0. 023）,that of watershed ischemic stroke was significantly higher in intracranial ＋ extracranial ICD group than in extracra- nial ICD group （59. 09% vs 28.00% ,P=0. 031） ,and that of massive ischemic stroke was signifi- cantly lower in patients with their anterior communicating artery opened than in those with their anterior communicating artery not opened （4.00% vs 23.08% ,P：0. 048）. Conclusion No signif- icant difference is found in the opening forms of Willis cicircle, which suggests that a variety of mechanisms are involved in the occurrence of ischemic stroke. However, the opening of anterior communicating artery can reduce the incidence of massive ischemic stroke.