颈内动脉窃血的血流动力学及影像学研究  

Hemodynamics and imaging of internal carotid artery steal

作　　者：王佳楠[1] 侯备[2] 张雄伟[1] 杜彬[3] 黄艾华[1] 尹世敏[1] 王磊[1] 

机构地区：[1]中国人民解放军火箭军总医院神经内科,北京100088 [2]中国人民解放军火箭军总医院重症医学科,北京100088 [3]中国人民解放军火箭军总医院神经介入医学科,北京100088

出　　处：《中华老年心脑血管病杂志》2016年第11期1133-1136,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨颈总动脉闭塞后颈内动脉窃血的血流动力学及影像学特点。方法选择经脑血管造影证实的一侧颈总动脉闭塞患者15例,通过经颅多普勒(TCD)、磁共振血管造影(MRA)、CT血管成像(CTA)和数字减影血管造影(DSA)综合评估颈内动脉窃血的侧支循环途径。结果 TCD检查显示,颈内动脉窃血的血流动力学特点为病变侧颈外动脉主干血流方向逆转(正向血流频谱)、血流频谱颅内化,病变侧颈内动脉起始段呈低钝血流频谱。DSA显示,颈内动脉窃血途径主要包括:侧支血流从病变侧椎动脉经枕动脉和颈外动脉窃至颈内动脉;侧支血流从病变侧甲状颈干和肋颈干经枕动脉和颈外动脉窃至颈内动脉;侧支血流从病变对侧颈外动脉经甲状腺上动脉吻合和病变侧颈外动脉窃至颈内动脉。MRA和CTA可显示颈总动脉闭塞情况;颈内动脉窃血时,可完整显示由于颈内动脉窃血代偿后正常显影的颈动脉分叉、颈内动脉和颈外动脉;参与侧支代偿的椎动脉和甲状颈干可正常显影。结论临床需结合TCD及影像学检查综合判定颈内动脉窃血的建立情况和具体窃血途径。Objective To study the characteristics of hemodynamics and imaging of internal carotid artery steal.Methods Fifteen patients with common carotid artery occlusion conformed by DSA were included in this study.Their collateral circulation at internal carotid artery steal was assessed by TCD,MRA,CTA and DSA respectively.Results TCD showed that the hemodynamics of internal carotid artery steal was characterized by retrograde flow of external carotid artery,antegrade flow of intracranial carotid artery,and low blunt flow at the starting segment of lesioned internal carotid artery.DSA showed that the ways of internal carotid artery steal included collateral blood flow into internal carotid artery from the occipital artery of lesioned vertebral artery and external carotid artery,collateral blood flow into internal carotid artery from the occipital artery of lesioned thyroid jugular trunk and costal trunk and external carotid artery,collateral blood flow into internal carotid artery from the superior thyroid artery anastomotic branch of contracollateral external carotid artery and lesioned external carodid artery.MRA and CTA showed common carotid artery occlusion,including carotid bifurcation,involved vertebral artery and thyroid trunk in collateral circulation compensation.Conclusion Establishment and ways of internal carotid artery steal can be judged by TCD in combination with imaging in clinical practice.

关 键 词：锁骨下动脉窃血综合征 血流动力学 脑血管造影术 磁共振血管造影术 血管造影术 数字减影 侧支循环 

分 类 号：R743.3[医药卫生—神经病学与精神病学]