经颅多普勒超声评估单侧颈内动脉颅外段闭塞患者颅内侧支循环的临床意义

Clinical significance of transcranial Doppler ultrasonography to evaluate intracranial collateral circulation in patients with extracranial segment of unilateral internal carotid artery occlusion

目的探讨经颅多普勒超声(TCD)评估单侧颈内动脉颅外段闭塞(ICAO)患者颅内侧支循环的临床价值。方法回顾性连续纳入2018年1月至2020年12月就诊于苏州大学附属第一医院卒中中心、行颈部血管超声检查为单侧ICAO及数字减影血管造影(DSA)证实患者145例,其中症状组109例,无症状组36例。记录TCD评估颅内侧支循环类型并与DSA行一致性检验;记录双侧大脑中动脉(MCA)的血流动力学参数及双侧基底节区、颞叶CT灌注(CTP)参数;根据美国介入和治疗神经放射学学会/介入放射学学会(ASITN/SIR)侧支循环评估系统将患者分为侧支循环不良(0~2级)及良好组(3~4级),比较两组患侧MCA参数及CTP参数差异;比较无症状组、症状组双侧MCA血流参数差异及Alberta卒中项目早期CT评分(ASPECTS)。结果(1)一致性分析:TCD评估前交通动脉(ACoA)、后交通动脉(PCoA)、眼动脉(OA)与DSA的符合率分别为:93.1%、91.0%、80.7%,一致性均佳(Kappa值=0.84、0.78、0.66,均P<0.05)(2)侧支循环代偿情况:侧支循环不良组患侧大脑中动脉平均流速(Vm)、收缩期峰值流速(Vs)、舒张期末流速(Vd)、脉动指数(PI)低于良好组,其中Vm、Vs、Vd差异具有统计学意义(P<0.05);基底节及颞叶CBF、CBV均减低,MTT、TTP均延长,差异具有统计学意义(均P<0.05)(3)无症状组ASPECTS显著高于症状组,且健患侧MCA血流参数差异小于症状组(均P<0.01)。结论TCD评估单侧颈内动脉颅外段闭塞患者颅内侧支循环与DSA有较好的一致性,MCA血流参数能反映其供血区域颅内灌注情况,是评估颅内侧支循环的有效工具。

Objective To investigate the clinical value of transcranial Doppler ultrasound(TCD)in evaluating intracranial collateral circulation in patients with extracranial segment of unilateral internal carotid artery occlusion(ICAO).Methods A total of 145 patients with ICAO,109 in the symptomatic group and 36 in the asymptomatic group,who were diagnosed by cervical vascular ultrasonography and confirmed by digital subtraction angiography(DSA)in the Stroke Center of the First Affiliated Hospital of Soochow University from January 2018 to December 2020,were retrospectively enrolled.TCD was recorded to evaluate intracranial collateral circulation types and performed consistency test with DSA.The hemodynamic parameters of bilateral middle cerebral artery(MCA)and CT perfusion(CTP)parameters of bilateral basal ganglia and temporal lobe were recorded.According to the Collateral circulation assessment system of the American Society for Interventional and Therapeutic Neuroradiology/Society for Interventional Radiology(ASITN/SIR),patients were divided into poor collateral circulation(grade 0~2)and good collateral circulation(grade 3~4),and the differences of MCA parameters and CTP parameters were compared between the two groups.The differences in bilateral MCA blood flow parameters between the asymptomatic group and the symptomatic group and the early CT scores(ASPECTS)of the Alberta Stroke Project were compared.Results(1)Consistency analysis:The coincidence rates of anterior communicating artery(ACoA),posterior communicating artery(PCoA),ocular artery(OA)and DSA evaluated by TCD were:93.1%,91.0%,80.7%,with good consistency(Kappa value=0.84,0.78,0.66,all P<0.05).(2)Collateral circulation compensation:The mean flow rate(Vm),peak systolic flow rate(Vs),end diastolic flow rate(Vd)and pulsation index(PI)of the affected middle cerebral artery in the poor collateral circulation group were lower than those in the good group,and the differences in Vm,Vs and Vd were statistically significant(P<0.05).CBF and CBV in basal ganglia and temporal lobe were decreased,while MTT and TTP were prolonged,with statistically significant differences(all P<0.05).(3)ASPECTS in asymptomatic group were significantly higher than those in symptomatic group,and blood flow parameters in MCA of healthy side were less different than those in symptomatic group(all P<0.01).Conclusion TCD is consistent with DSA in evaluating intracranial collateral circulation in patients with intracranial extracranial occlusion of unilateral internal carotid artery.MCA blood flow parameters can reflect the perfusion in the blood supply area,and TCD is an effective tool for evaluating intracranial collateral circulation.