慢性颈内动脉闭塞脑侧支循环血流代偿与脑梗死的关系

Relationship between blood flow compensation in cerebral artyery collateral circulation and cerebral infarction in patients with EICAO

目的分析慢性单侧颈内动脉颅外段闭塞(EICAO)的脑动脉侧支循环开放和患侧大脑中动脉(MCA)血流动力学变化与脑梗死的关系。方法选择慢性单侧EICAO患者96例,其中左侧EICAO 46例和右侧EICAO 50例。应用彩色经颅多普勒超声检测前交通动脉(ACOA)、后交通动脉(PCOA)、眼动脉(OA)侧支循环血管开放率、远端MCA的收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、平均血流速度(Vm)等,头颅MRI检查MCA供血区脑梗死灶发病率。结果左侧与右侧EICAO的ACOA开放率(63.04%vs 60.00%),PCOA开放率(60.87%vs 66.00%)无明显差异(P>0.05),OA开放率有明显差异(69.57%vs 56.00%,P=0.040)。左和右侧EICAO患者患侧MCA的Vs、Vd和Vm均明显低于健侧(P<0.05,P<0.01)。侧支循环单支开放、双支开放和3支开放脑梗死比例比较,差异有统计学意义(68.75%vs 61.36%vs 45.00%,P=0.002)。结论 EICAO患者有不同程度的ACOA、PCOA和OA侧支循环开放,但患侧MCA供血区仍然易发低灌注性脑缺血损害。

Objective To analyze the relationship of cerebral artery collateral circulation and MCA hemodynamic changes with cerebral infarction in patients with chronic external and internal carotid artery occlusion(EICAO).Methods Ninety-six chronic EICAO patients(46 with left EICAO and 50 with right EICAO)were included in this study.The open rates of collateral circulation in anterior communicating artery(ACOA),posterior communicating artery(PCOA),ocular artery(OA),and systolic peak blood flow velocity(Vs),end-stage blood flow velocity(Vd)and mean blood flow velocity(Vm)in distal MCA were measured by transcranial color Doppler ultrasonography.The PI and incidence of cerebral infarction in MCA were assayed by head MRI.ResultsNo significant difference was found in the open rate of left and right ACOA and PCOA(63.04%vs 60.00%,60.87%vs 66.00%,P>0.05).The open rate of OA was significantly higher in patients with left EICAO than in those with right EICAO(69.57% vs 56.00%,P=0.040).The Vs,Vd and Vm were significantly lower in affected MCA than in healthy MCA(P<0.05,P<0.01).The open rate of collateral circulation was significantly higher in single branch than in double and triple branches(68.75% vs 61.36%vs 45.00%,P=0.002).Conclusion The open rate of collateral circulation in ACOA,PCOA and OA is different in EICAO patients.Hypoperfusion-induced cerebral ischemic damage is easy to occur in the blood supply area of affected MCA.