老年颈内动脉系统动脉闭塞患者的侧支循环代偿能力评估

目的探讨老年颈内动脉系统动脉闭塞患者的倒支循环代偿能力。方法对170例经数字减影血管造影或磁共振血管造影证实的颈内动脉系统动脉闭塞老年患者，采用经颅多普勒（TCD）技术检测侧支循环通路。结果颈内动脉颅外段闭塞，TCD显示大脑中动脉异常波型（MCAAW）68％，大脑中动脉血流速度降低（MCAVR）66％，眼动脉血流方向逆转（ROA）70％，前交通动脉（ACoA）开放80％，后交通动脉（PCoA）开放71％。颈内动脉远段闭塞，TCD显示MCAAW90％，MCAVR68％，ROA15％，ACoA开放51％，PCoA开放61％。大脑中动脉闭塞，TCD显示大脑中动脉血流信号消失67％，MCAAW和MCAVR33％，软脑膜吻合侧支开放100％。结论TCD有助于了解颈内动脉系统动脉闭塞患者的侧支循环代偿能力，为评估治疗效果和预后提供重要的客观依据。

Collateral compensative capacity assessment in aged patients with artery occlusion of internal carotid artery system

Objective] To explore the collateral compensative capacity in aged patients with artery occlusion of internal carotid artery system. Methods] In 170 aged patients with artery occlusion of internal carotid artery system determined by digital subtraction or MR angiography, the collateral circulation pathway was measured by transcranial Doppler(TCD). Results] With extracranial internal carotid artery occlusion, TCD showed abnormal middle cerebral artery waveforms (MCAAW) in 68%, blood flow velocity reduction of middle cerebral artery(MCAVR) in 66%, reversed ophthalmic artery (ROA) in 70%, anterior cross-filling via anterior communicating artery (ACoA) in 80%, posterior communicating artery (PCoA) in 71% of patients. With distal internal carotid artery occlusion, TCD showed MCAAW in 90%, MCAVR in 68%, ROA in 15%, ACoA in 51%, PCoA in 61% of patients. With middle cerebral artery occlusion, TCD showed middle cerebral artery flow signal disappearance in 67%, MCAAW and MCAVR in 33%, leptomeningeal anastomoses in 100% of patients. Conclusions] TCD might furtherly help to know the collateral compensative capacity in patients with artery occlusion of internal carotid artery system. It was suggested that TCD might be important and objective index in evaluating the treatment effect and the prognosis.