DSA评价颈内动脉重度狭窄或闭塞患者侧支循环与临床表现的关系

Study of the Relationship between DSA Collateral Circulation Feature and Clinical Symptom for Patients with Severe Internal Carotid Artery Stenosis or Occlusion

目的利用数字减影血管造影(digital subtraction angiography,DSA)技术研究颈内动脉重度狭窄或闭塞患者侧支循环状态,评估其与临床表现的相关性。方法本研究为回顾性研究,连续纳入首都医科大学附属北京天坛医院介入神经病学科2014年6月-2015年9月经DSA诊断为颈内动脉重度狭窄(≥70%)或闭塞患者137例,根据是否出现与责任血管相关的脑缺血症状和(或)神经系统定位体征,分为症状性狭窄组98例和无症状性狭窄组39例,收集所有患者DSA检查结果,记录患者侧支循环代偿情况。将患者侧支循环状态按以下情况进行分类:(1)侧支循环开放数量:分为未出现侧支和出现侧支组;根据侧支出现数量多少,分为出现侧支数<2和出现侧支数≥2两组。(2)各侧支循环开放情况:前交通动脉(anterior communicating artery,ACoA),后交通动脉(posterior communicating artery,PCoA),眼动脉(ophthalmic artery,OA),软脑膜吻合支(leptomeningeal anastomoses,LMA)。(3)组合侧支开放情况:组合侧支按两种分类,一种根据Willis环开放情况,一种根据是否出现二级侧支循环,分析组合侧支循环状态与两组间的关系。结果共137例患者,年龄范围34~82岁,平均(59.7±10.5)岁,其中男性97例(70.8%),所有患者出现侧支循环者94例(68.6%),出现功能完整Willis环、ACoA、PCoA、OA、LMA的概率分别为14.6%、58.5%、46.8%、43.6%、48.9%。无症状组39例,33例(84.6%)侧支循环开放;症状组98例,61例(62.2%)侧支循环开放,无症状组侧支开放率显著高于症状组[84.6%vs 62.2%,P=0.011,优势比(odds ratio,OR)=3.336],无症状组侧支数量≥2的患者所占比例显著高于症状组(64.1%vs 38.3%,P=0.007,OR=2.820),无症状组功能完整Willis环者显著高于症状组(36.4%vs 13.1%,P=0.009,OR=3.786)。结论在颈内动脉重度狭窄或闭塞时,侧支循环与患者的临床表现密切相关,无症状的患者有更丰富的侧支循环代偿途径及更完整Willis环,Willis环在侧支循环代偿中起重要作用。

Objective To evaluate collateral circulation features for patients with severe internal carotid artery（ICA） stenosis or occlusion by Digital Subtraction Angiography（DSA）, and study the relationship between collateral circulation feature and clinical symptom.Methods It was a retrospective study. A total of 137 patients with ICA severe stenosis（≥70%） or occlusion confirmed by DSA were consecutively enrolled during June 2014 to September 2015 in Dept. of Neurology Intervention, Beijing Tiantan Hospital, Capital Medical University. Patients were divided into asymptomatic group（n=39） and symptomatic group（n=98） according to clinical symptoms, neurological signs and imaging appearance. The DSA results of all patients were collected and collateral circulation compensation status were recorded. Patients＇ collateral circulation status were classified by following situation： 1. Numbers of collaterals： Patients were classified to with or without collateral circulation by collateral numbers and less than 2 or 2 and more. 2. Collateral circulation status： anteriorcommunicating anastomoses（ACoA）, posterior communicating arteries（PCoA）, ophthalmic artery（OA）, and leptomeningeal anastomoses（LMA）. 3. Collateral composition： collaterals were classified according to Willis status and whether have secondary collaterals. The relationship between collateral circulation feature and clinical symptoms was analyzed.Results Among 137 patients, the mean age of patients was（59.7±10.5） years, 97 patients were male, and 94 patients（68.6%） had collaterals. The rate of complete Willis, ACoA, PCoA, OA, and LMA were 14.6%, 58.5%, 46.8%, 43.6%, and 48.9%, respectively. In asymptomatic group（n=39）, 33 patients（84.6%） had collateral circulation. In symptomatic group（n=98）, 61 patients（62.2%） had collateral circulation. The rate of circulation was significantly higher in asymptomatic group [84.6% vs 62.2%, P=0.011, odds ratio（OR） 3.336]. Patients in asymptomatic group had more patients with 2 or more collaterals than patients in symptomatic group（64.1% vs 38.3%, P=0.007, OR 2.820）.Asymptomatic group had more complete functional Willis（36.4% vs 13.1%, P=0.009, OR 3.786）.Conclusion For patients with severe internal carotid artery（ICA） stenosis or occlusion, collateral circulation feature has close relationship with clinical symptom. Asymptomatic patients have more collateral circulation compensatory and more complete circle of Willis. The circle of Willis plays an important role in the compensation of collateral circulation.