颈内动脉狭窄或闭塞临床表现类型与脑侧支循环的关系  

Relationship between collateral circulation and categories of clinical manifestation after severe stenosis or occlusion of internal carotid artery

作　　者：郭洪伟[1] 吕伟[1] 曹秉振[1] 

机构地区：[1]第二军医大学临床学院.济南军区总医院神经内科,山东济南250031

出　　处：《实用医药杂志》2012年第7期577-579,581,共4页Practical Journal of Medicine & Pharmacy

摘　　要：目的探讨颈内动脉重度狭窄或闭塞患者临床表现类型与颅内侧支循环之间的关系。方法 60例颈内动脉狭窄或闭塞患者依据临床表现分为脑梗塞、短暂性脑缺血(TIA)及无症状性梗塞3组,采用数字减影脑血管造影技术(DSA)对3组患者颅内动脉的侧支循环代偿情况进行了评价并分析了侧支循环建立与临床表现类型的关系。结果 60例患者中血管闭塞25例,重度狭窄35例。Willis动脉环侧枝开放43例(71.6%),17例(28.4%)未开放,3组间有统计学差异(P<0.05),Willis动脉环开放的越充分,患者越不易发展为脑梗塞。60例中颈内动脉单部位病变为30例,多部位病变30例,3组间无统计学差异(P>0.05)。前交通支开放34例,后交通支开放27例,眼动脉开放10例,软脑膜吻合支开放24例,3组间无统计学差异(P>0.05)。结论颈内动脉重度狭窄或闭塞患者临床表现类型与Willis动脉环开放与否及程度密切相关,脑梗塞患者Willis动脉环开放比例相对TIA和无症状患者明显减少。Objective To explore the relationship between collateral circulation and categories of clinical manifestation after severe stenosis or occlusion of internal carotid artery. Methods According to the clinical manifestation, the 60 patients were divided into three groups （cerebral infarction, transient ischemie attack, and asymptomatie group）, and digital subtraction angiography （DSA） was employed to evaluate the compensation of collateral circulation then to analyze the obtained results through statistical methods. Results DSA demonstrated occlusion of ICA in 25 patients, severe stenosis of ICA in 35 patients. Willis circle compensation appeared in 43 patients （71.6%）, Willis circle uncompensation appeared in 17 patients （28.4%）. Significant differences among the three group were found in Willis circle and without Willis circle （P〈0.05）; DSA demonstrated lesion of alone position in ICA in 30 patients, and lesion of multi-position in ICA in 30 patients. No significant differences were found among three groups （P〉0.05）. The anterior communicating artery （ACOA）opened in 27 （56.7%）, posterior communicating artery （PCOA） opens in 27 （45.0%）, ophthalmic artery （OA）opened in 10 （16.7%）, leptomeninged collateral anastomosis （LEP）opened in 24（40.0%）, no significant differences were noted among three groups（P〉0.05）. Conclusion The categories of the clinical symptoms are closely related to Willis circle after severe stenosis or occlusion of internal carotid artery. Willis cirel open is better than Willis cirel unopen in improving the clinical symptoms and Willis eircl open can significantly decrease ischemic stroke quantity.

关 键 词：颈内动脉狭窄 颈内动脉闭塞 侧支循环 脑血管造影 WILLIS动脉环 

分 类 号：R743.33[医药卫生—神经病学与精神病学]