颅底动脉环异常与老年人缺血性脑血管病关系临床探讨

目的探讨颅底动脉环(Willis)的形态变异与缺血性脑血管病的关系,为临床治疗方法选择提供解剖依据。方法采用数字减影血管造影技术(DSA)对64例老年缺血性脑血管病患者行主动脉弓和全脑血管造影,应用A1优势征判断Willis前环的完整性,以大脑后动脉供血类型判断Willis后环的完整性。结果本组病人中A1优势征者43.8%;大脑后动脉供血为基底动脉供血型者40.6%;颈动脉供血型者21.9%;混合供血型者37.5%。共检出血管狭窄31例,临床症状和血管狭窄部位符合者23例(74.2%),不符者8例(25.8%)。结论Willis前环的A1优势征和Willis后环中大脑后动脉供血为颈动脉供血型、混合供血型者提示Willis动脉环形态变异;形态异常的Willis动脉环与缺血性脑血管病的发病及发病后的血流动力学代偿密切相关;血流动力学的改变可通过侧支循环造成临床症状和血管狭窄部位不符,可能影响脑梗死后血管活性药物的选择及超选择性动脉溶栓时溶栓部位的选择。

A Clinical Study of the Relationship Between Willis Arterial Circle Abnormality and Ischemic Cerebrovascular Disease in Aged People

Objective To investigate the relationship between basal arterial circle(Willis circle) abnormality and ischemic cerebrovascular disease in aged people and to provide anatomical evidences for clinical intervention. Methods Digital subtraction angiography (DSA) technique was used for aortic arch and cranial angiography in 64 patients with ischemic cerebrovascular disease. The integrality of anterior Willis circle was judged by A1 odds sign and the integrality of posterior Willis circle was judged by blood-supply type of posterior cerebral artery (PCA). Results A1 odds sign were found in 43.75% patients, the blood-supply of PCA origining from basilar artery was 40.63% and carotid artery 21.87%. Mixed blood- supply of PCA was 37.5%. Thirty-one patients were found with stenosis, clinical symptom in 23 patients of them(74.19%), were significant correlated to the locations of stenosis, but clinical symptoms in 8 patients (25.81%) were no correlated to the locations of stenosis. Conclusion A1 odds sign in anterior Willis circle and the blood-supply type of PCA such as carotid artery type or mixed blood-supply type may hint Willis arterial circle heteromorphosis. Paramorph Willis arterial circle is correlated to ischemic cerebrovascular disease and hemodynamics compensation. The changes of hemodynamics can result in clinical symptom inconsistent with the location of stenosis by collateral circulation. These results indicate the changes of hemodynamics becauses of Willis arterial circle abnormality may influence on the choice of vasoactive agents and the location of ultraselective artery thrombolysis.