颈内动脉颅外段血流动力学变化与颅内段病变的相关分析

Evaluation of correlation between the hemodynamic parameters of extracranial internal carotid artery and intracranial internal carotid artery stenosis or occlusion

目的通过颈动脉彩色多普勒血流显像(CDFI)检测分析颅外段颈内动脉(ICA)血流动力学参数变化与颅内段狭窄或闭塞性病变的相关性。方法回顾性连续纳入2016年1月至2018年12月首都医科大学宣武医院神经内、外科因缺血性卒中或短暂性脑缺血发作住院的患者。入院后常规行颈动脉CDFI检查,经DSA证实为单侧颅内段ICA狭窄或闭塞患者共288例,并根据病变程度将患者分为<70%狭窄组(136例)、70%~99%狭窄组(86例)、闭塞组(66例)3组;选择同期DSA证实无颅内段ICA病变的缺血性卒中或短暂性脑缺血发作者为对照组(122例)。比较4组间颅外段ICA收缩期峰值流速(PSV)、舒张期末流速(EDV)、血管阻力指数(RI)的差异性,分析4组间颅外段ICA CDFI频谱特征。结果410例患者检测结果分析显示:(1)ICA颅内段70%~99%狭窄组、闭塞组患者的脑梗死发生率明显高于<70%狭窄组、对照组[分别为73.3%(63/86)、95.5%(63/66)、31.6%(43/136)、26.2%(32/122);均P<0.01]。(2)ICA颅内段70%~99%狭窄组和闭塞组患者的患侧ICA颅外段PSV、EDV明显低于<70%狭窄组[PSV:(41±14)、(40±13)cm/s比(86±15)cm/s;EDV(13±7)、(10±4)cm/s比(33±8)cm/s],而RI值明显升高[(0.69±0.12)、(0.77±0.05)比(0.62±0.06)],闭塞组患者ICA颅外段EDV明显低于70%~99%狭窄组,RI明显高于70%~99%狭窄组,差异均有统计学意义(均P<0.05);70%~99%狭窄组和闭塞组颅外段ICA CDFI血流频谱呈现低速高阻力性血流改变特征,闭塞组患侧ICA颅外段表现为舒张期血流消失者占1.5%(1/66例),舒张期血流方向逆转者占48.5%(32/66)。结论ICA颅内段70%~99%狭窄或闭塞时,颅外段ICA CDFI频谱特征呈现低速高阻力性血流动力学改变。ICA颅外段出现“振荡”频谱时,高度提示ICA颅内段闭塞。

Objective To explore the correlation between the hemodynamic parameter of the extracranial internal carotid artery(EICA)and intracranial internal carotid artery(IICA)stenosis or occlusive lesions with carotid artery color Doppler flow imaging(CDFI).Methods A total of 288 patients who had an ischemic stroke or transient ischemic attack caused by unilateral IICA stenosis or occlusion in the Department of Neurology and Neurosurgery of Xuanwu Hospital,Capital Medical University,were continuously enrolled from January 2016 to December 2018,which was confirmed by digital subtraction angiography(DSA).Then,all patients were divided into three trial groups of stenosis degree less than 70%(n=136),stenosis degree from 70%to 99%(n=86)and occlusion(n=66)according to the degree of lesions.Meanwhile,the control group(122 cases)was selected without of IICA lesion confirmed by DSA.The difference of peak systolic velocity(PSV),end-diastolic velocity(EDV),resistance index(RI)in the EICA among the four groups was compared.Moreover,the waveform of CFDI in the four groups was analyzed.Results A total of 410 patients were measured.The results were described as follows:(1)The incidences of cerebral infarction in patients with 70%-99%of stenosis and occlusion of IICA were significantly higher than that of patients in less than 70%of stenosis group and control groups(73.3%[63/86],95.5%[63/66],31.6%[43/136],26.2%[32/122],respectively.all P<0.01).(2)The ipsilateral PSV and EDV of EICA in patients with 70%-99%of stenosis or occlusion of IICA were significantly lower than that in patients with less than 70%stenosis(PSV:[41±14]cm/s,[40±13]cm/s vs.[86±15]cm/s;EDV:[13±7]cm/s,[10±4]cm/s vs.[33±8]cm/s).The value of RI was increased significantly in patients with 70%-99%of stenosis or occlusion of IICA compared to patients of less than 70%stenosis of IICA(0.69±0.12,0.77±0.05 vs.0.62±0.06).The ipsilateral EDV was significantly lower but the RI was significantly higher in patients with occlusion of IICA compared to patients with 70%-99%of stenosis of IICA,which was statistically significant(all P<0.05).The blood flow waveform showed the characteristics of low speed and high resistance in patients with 70%-99%of stenosis and occlusion of IICA.In particular,1.5%(1/66)of patients with occlusion of IICA showed the absence of diastolic blood flow in ipsilateral EICA.48.5%[32/66]of patients with occlusion of IICA had blood flow direction reversal.Conclusions The waveform of EICA is characterized as a low speed with high resistance in patients with 70%-99%of stenosis or occlusion of ipsilateral IICA.Moreover,if the diastolic waveform is the reversal in EICA,it is highly indicating the occlusion of IICA.