单侧颈内动脉狭窄或闭塞后侧支循环与脑缺血关系的研究  

The Study of the Relation Between the Collateral Circulation and Cerebral Ischemia Due to Unilateral Internal Carotid Artery Stenosis or Occlusion

作　　者：陈济铭[1] 张涛[1] 郑惠[1] 万仁均[1] 

机构地区：[1]福建医科大学附属第一医院介入科,福州350005

出　　处：《临床放射学杂志》2013年第5期714-719,共6页Journal of Clinical Radiology

摘　　要：目的探讨单侧颈内动脉狭窄或闭塞后侧支循环与脑缺血的关系。方法对比分析68例单侧颈内动脉狭窄或闭塞患者(实验组)及20例脑血管DSA检查正常者(对照组)的临床资料及数字减影血管造影(DSA)表现。结果 (1)实验组68例中,狭窄或闭塞发生于颈内动脉41例、大脑中动脉17例、大脑前动脉A1段4例、大脑前动脉A1段以远6例。发现侧支循环开放代偿共109例次,其中前交通动脉32例次、后交通动脉22例次、后软脑膜吻合27例次、前软脑膜吻合19例次、眼动脉4例次、穿支动脉2例次、其他3例次。重度狭窄组与闭塞组侧支循环开放率较高,分别为72.7%、86.7%,与正常对照组差异有显著性(χ2=14.029、25.301,P均<0.001);轻、中度狭窄组侧支循环开放率较低,分别为为16.7%、20.0%,与正常对照组差异无显著性(P=0.676、P=0.551)。(2)初级侧支循环开放的比例:症状组小于无症状组,差异有显著性(P=0.042);次级侧支循环开放的比例:症状组大于无症状组,差异有显著性(P=0.022)。前交通动脉开放的比例:症状组小于无症状组,差异有显著性(P=0.038);后交通动脉开放的比例:症状组与无症状组无显著性差异(P=0.382)。(3)Willis前环变异:症状组最高,其次为正常对照组,而无症状组变异率最低,三组间差异有显著性(P=0.032);Willis后环变异比例:三组间差异无显著性(P=0.110)。(4)颈内动脉闭塞的26例,侧支血流评分:梗死组得分最低为(2.4286±0.17271)分,其次为TIA组(3.2500±0.2500)分,最高的为无症状组(3.7500±0.16366)分,三组间差异有显著性(F=13.903,P<0.001)。结论 DSA对侧支循环状况的分析、评估具有非常重要的价值,能为颈内动脉狭窄或闭塞的诊断、治疗、预后提供较全面的评价。Objective To discuss the relation between the collateral circulation and cerebral ischemia due to unilateral internal carotid artery（ICA） stenosis or occlusion.Methods 68 patients with unilateral ICA stenosis or occlusion on DSA were set as the observation group,20 patients with normal DSA findings were set as control group.Both clinical data and DSA findings were analyzed between the two groups.Results（1）Among observation group,the number of stenosis or occlusion taken place in ICA was 41,MCA 17,A1 segment of ACA in 4,distal A1 segment of ACA in 6;The numbers of opened collateral circulation observed is 109 in 68 patients,among which： ACOA is 32,PCOA is 22,post leptomeningeal anastomosis is 27,former leptomeningeal anastomosis is 19,ophthalmic artery is 4,perforating branches is 2,the others is 3.The proportion of opened collateral circulation of serious stenosis group and occlusion group were the highest,which were 72.7% and 86.7% respectively,and they were different from control group significantly（χ2=14.029、25.301,P0.001）;mild and moderate stenosis groups respectively were 16.7% and 20.0%,which had no significant difference from control group（P= 0.676,P=0.551）.（2）The proportion of opened primary collateral circulation：symptomatic group is less than asymptomatic group（P=0.042）;the proportion of opened secondary collateral circulation： symptomatic group was more than asymptomatic group（P= 0.022）;The proportion of opened anterior communicating artery： symptomatic group was less than asymptomatic group（P=0.038）;the proportion of opened posterior communicating artery： symptomatic group and asymptomatic group were same（P= 0.382）.（3）The ratio of variation of anterior circle： symptomatic group was the highest,followed by the normal control group,while the lowest rate of variation was asymptomatic group（P=0.032）;The ratio of variation of posterior circle： no significant difference was found among the three groups（P=0.110）.4.Occlusion of internal carotid

关 键 词：数字减影血管造影 颈内动脉 狭窄或闭塞 侧支循环 缺血性脑血管病 

分 类 号：R743.3[医药卫生—神经病学与精神病学]