双侧颈内动脉重度狭窄/闭塞患者侧支循环代偿模式分析

Collateral circulation compensation mode in patients with severe bilateral internal carotid artery stenosis/occlusion

目的:探讨双侧颈内动脉重度狭窄/闭塞侧支循环代偿模式。方法:回顾性分析2017年5月至2020年6月齐齐哈尔医学院附属第二医院和解放军总医院第六医学中心诊治的42例双侧颈内动脉重度狭窄/闭塞患者的临床、影像学资料,入组病例通过医院伦理委员会批准。由2名神经内科、2名影像科高资历医师组成血管狭窄评估小组,采用盲法阅片对狭窄动脉及侧支循环进行评定。通过经颅多普勒(TCD),CT血管成像,磁共振血管成像评估狭窄。在数字减影血管造影(DSA)下,采取改良Seldinger技术进行股动脉穿刺,分别对主动脉弓、锁骨下动脉、颈总动脉进行全脑血管造影。依据双侧颈内动脉重度狭窄/闭塞的部位,将血流代偿模式分为4型。观察入组患者的狭窄/闭塞侧支循环代偿模式类型。数据进行描述性分析。结果:42例患者中男性34例、女性8例,年龄48~82(61±8)岁。启动侧支循环途径:前交通动脉侧支、后交通动脉侧支、眼动脉侧支、大脑后动脉-大脑中动脉软脑膜吻合侧支、脉络膜后动脉-脉络膜前动脉侧支循环、颈外动脉-颈内动脉C4段侧支循环、胼周动脉吻合侧支、硬脑膜-软脑膜侧支、新生血管。Ⅰ型双侧颈内动脉C1段重度狭窄/闭塞20例(47.6%);Ⅱ型双侧颈内动脉C2段至C6段眼动脉发出前重度狭窄/闭塞5例(11.9%);Ⅲ型双侧颈内动脉C6段眼动脉发出后重度狭窄/闭塞2例(4.8%);Ⅳ型混合型15例(35.7%)。结论:双侧颈内动脉重度狭窄/闭塞侧支循环途径与病变部位密切相关,探讨其侧支循环代偿模式分型,有助于临床医师准确分析病变特点及指导个体化介入治疗。

Objective To investigate the correlation between collateral flow compensation mode and interventional treatment decision in patients with severe bilateral internal carotid artery stenosis/occlusion.Methods According to the location of internal carotid artery lesions,patients with severe stenosis/occlusion of bilateral internal carotid artery were selected at the Second Affiliated Hospital,Qiqihar Medical University and the Sixth Medical Center of PLA General Hospital from May 2017 to June 2020.Results A total of 42 patients were finally enrolled and divided into 4 types,including 34 males and 8 females with median age 61±8(48-82)years.The collateral circulation pathways manifested as following modes:anterior communicating artery collateral,posterior communicating artery collateral,ophthalmic artery collateral,posterior cerebral middle cerebral artery pial anastomosis collateral,posterior choroidal artery anterior choroidal artery collateral,external carotid internal carotid artery C4 segment collateral,pericallosal artery anastomosis collateral,dural and pial collateral and neovascularization.TypeⅠsevere stenosis/occlusion of C1 segment was found in 20 cases(47.6%).There were 5 cases(11.9%)of typeⅡsevere stenosis/occlusion from C2 to C6 prior to ophthalmic artery branch.TypeⅢsevere stenosis/occlusion occurred in 2 cases(4.8%)after the split of ophthalmic artery.TypeⅣwas mixed type in 15 cases(35.7%).Conclusions The compensatory pathway of collateral circulation is closely related to the lesion location.To explore the compensatory pattern of collateral circulation is helpful for clinicians to accurately analyze the lesion characteristics and guide individualized interventional therapy.