DSA对单侧颈内动脉系统大动脉狭窄或闭塞后侧支循环建立的应用价值

目的 探讨DSA对单侧颈内动脉系统大动脉狭窄或闭塞后侧支循环建立的应用价值,探讨三级侧支循环在单侧颈内动脉开口部位狭窄或闭塞及大脑中动脉M1段狭窄或闭塞中的特点.方法 分别对56例颈内动脉开口处狭窄或闭塞及94例大脑中动脉M1段狭窄或闭塞的患者进行脑血管造影检查,根据其狭窄程度分析其侧支循环建立的情况.结果 颈内动脉开口部位闭塞组大脑动脉环开放率约38.5%,颅内外沟通开放率30.8%,软脑膜吻合支开放率约30.8%;重度狭窄组大脑动脉环开放率35.1%,软脑膜吻合支开放率16.2%,颅内外沟通开放率约5.4%;中轻度狭窄组无侧支循环建立.大脑中动脉M1段闭塞组大脑动脉环开放率5%,软脑膜吻合支开放率95%;重度狭窄组仅软脑膜吻合支开放,开放率约61%;轻中度狭窄组无侧支形成.结论 在颈内动脉开口部位重度狭窄或闭塞的病例中,一级侧支循环的开放代偿最为重要,二级侧支循环起着重要的辅助作用.在大脑中动脉M1段重度狭窄或闭塞的病例中,二级和三级侧支循环的开放起主要的代偿作用.

Research on the application of DSA to the establishment of collateral circulation after main artery stenosis or oc-clusion in unilateral internal carotid artery system

Objective To assess the application of DSA to the establishment of collateral circulation after main artery steno-sis or occlusion in unilateral internal carotid artery system and to explore the respective characters of three-level collateral circula-tion in the opening of unilateral internal carotid artery stenosis or occlusion and in M1 segment stenosis or occlusion of middle cer-ebral artery.Methods We carried out cerebral angiography examination respectively in 56 patients with internal carotid artery ste-nosis or occlusion and in 94 patients with M1 segment stenosis or occlusion of middle cerebral artery cerebral,and we analyzed the condition of the establishment of collateral circulation according to the degree of stenosis.Results In the group with occlusion in internal carotid artery,opening rates of Willis circle,communicatiin between the intracranial and extracranial,leptomeningeal anas-tomatic brach were about 38.5%,30.8% and 30.8%,respectively,and which were about 35.1%,5.4% and 16.2%,respectively in severe cerebral artery stenosis group.There was no establishment of collateral circulation in mild stenosis group.While in the group with M1 segment of middle cerebral artery occlusion,Willis circle opening rate was 5% and opening rate of leptomeningeal anastomatic brach was 95%.Only leptomeningeal anastomatic brach was open in the severe stenosis group and the opening rate was about 61%.No formation of collateral circulation in the mild group.Conclusion The compensation of first-level collateral cir-culation plays the most important role in cases with severe stenosis or occlusion in internal carotid artery,and the second-level col-lateral circulation can have an auxiliary effect.The compensation of second-level and third-level collateral circulation play major roles in cases with severe stenosis or occlusion of M1 segment stenosis or occlusion of middle cerebral artery.