Willis环不同代偿能力对颈动脉重度狭窄患者脑血流灌注差异的对比研究  

Comparison of cerebral blood flow perfusion in patients with severe carotid artery stenosis by different compensatory capacities of COW

作　　者：温宏峰[1] 赵春霞[1] 贺大权[1] Wen Hongfeng;Zhao Chunxia;He Daquan(Department of Neurology,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院神经内科,北京100049

出　　处：《中华老年心脑血管病杂志》2023年第3期268-271,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京市科技计划项目(Z181100001718095)。

摘　　要：目的探讨单侧颈动脉重度狭窄患者,在行颈动脉血流重建前后,Willis环的不同代偿能力对脑血流灌注的差异性。方法选择2018年6月至2022年6月航天中心医院神经科就诊的单侧颈动脉狭窄程度70%~99%患者65例,根据在数字减影血管造影术下压颈试验证实经Willis环代偿能力依据改良脑梗死溶栓分级(mTICI)分为代偿良好组33例(mTICI≥2b)和代偿不良组32例(mTICI≤2a)。代偿良好组和代偿不良组术前颈动脉狭窄率<90%患者分别为20例和19例,代偿良好组和代偿不良组术前颈动脉狭窄率≥90%患者分别为13例和13例。所有患者均行狭窄处支架置入手术,术前、术后均完善CT灌注成像检测相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对平均通过时间(rMTT)、相对达峰时间(rTTP)。结果代偿不良组术前rCBF略低于代偿良好组,差异无统计学意义(P>0.05)。代偿不良组术前rCBV、rMTT、rTTP明显高于代偿良好组,差异有统计学意义(1.04±0.03 vs 1.02±0.02,1.19±0.12 vs 1.06±0.07,1.28±0.16 vs 1.10±0.09,P<0.01);2组术后rCBV、rCBF、rMTT、rTTP比较,差异无统计学意义(P>0.05)。代偿不良组颈动脉狭窄率<90%患者术前rCBV、rMTT、rTTP明显高于代偿良好组,差异有统计学意义(P<0.01)。代偿不良组颈动脉狭窄率≥90%患者术前rCBV、rMTT、rTTP明显高于代偿良好组,rCBF明显低于代偿良好组,差异有统计学意义(P<0.01)。结论Willis环能够改变颈动脉重度狭窄患者的脑血流分布,而且颈动脉狭窄越重,Willis环的代偿功能体现的越明显,在进行颈动脉狭窄血流重建时,要充分考虑和评估Willis环的代偿功能。Objective To investigate the difference in cerebral blood perfusion in patients with severe unilateral carotid artery stenosis before and after carotid artery blood flow reconstruction with different compensatory capacities of the circle of Willis(COW).Methods A total of 65 patients with unilateral carotid artery stenosis of 70%-99%admitted in our department from June 2018 to June2022 were recruited in this study.According to the result of digital subtraction angiography(DSA)carotid compression test,they were divided into 33 patients with COW compensation and modified Thrombolysis in Cerebral Infarction scale(mTICI)≥2b(good compensation group)and 32 patients with mTICI≤2a(poor compensation group).There were 20 and 19 patients with preoperative carotid stenosis of<90%in the good and poor compensation groups,respectively,and 13 and 13 patients with preoperative stenosis≥90%in the 2 groups,respectively.All patients underwent stent implantation for stenotic artery,and CT perfusion imaging was performed before and after operation for relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),relative mean transit time(rMTT)and relative peak time(rTTP).Results The preoperative rCBF was slightly lower in the poor compensation group than the good compensation group,with no significant difference(P>0.05).The poor compensation group had significantly higher preoperative rCBV,rMTT and rTTP than the good compensation group(1.04±0.03 vs 1.02±0.02,1.19±0.12 vs 1.06±0.07,1.28±0.16 vs 1.10±0.09,P<0.01).But no such differences were seen in postoperative rCBV,rCBF,rMTT and rTTP between the 2 groups(P>0.05).Preoperative rCBV,rMTT and rTTP were notably higher in the patients with carotid stenosis of<90%from the poor compensation group than from the good group(P<0.01).The patients with carotid stenosis of≥90%from the poor compensation group had statistically higher rCBV,rMTT and rTTP,but lower rCBF than those from the good compensation group(P<0.01).Conclusion COW can change the cerebral blood flow distribu

关 键 词：大脑动脉环 代偿 颈动脉狭窄 脑血管循环 

分 类 号：R743.3[医药卫生—神经病学与精神病学]