Cerebral vasomotor reactivity predicts the development of acute stroke in patients with internal carotid artery stenosis

Objective

To investigate the relationship between cerebral vasomotor reactivity (VMR) and acute stroke in patients with internal carotid artery stenosis.

Long‐term follow‐up of patients with asymptomatic occlusion of the internal carotid artery with good and impaired cerebral vasomotor reactivity

Background: Cerebral hemodynamic status might be prognostic for either the symptomatic or asymptomatic course of carotid occlusive disease. It is determined by evaluating cerebral vasomotor reactivity (VMR). We assessed VMR in asymptomatic patients with total occlusion of the internal carotid artery (ICA) and followed them to evaluate the role of impaired VMR in predicting ischaemic stroke (IS). Methods: Thirty‐five patients (21 men, mean age ± SD 68 ± 7.5 years) with unilateral asymptomatic ICA occlusion were studied by transcranial Doppler and the Diamox test (intravenous 1.0 g acetazolamide) and followed for 48 months or until reaching the end‐points of IS, transient ischaemic attack, or vascular death. VMR% was evaluated by recording the percent differences in peak systolic blood flow velocities in each middle cerebral artery at baseline and after Diamox administration. Results: Based on VMR% calculations, 14 (40%) patients had good VMRs and 21 (60%) had impaired VMRs. The global annual risk of ipsilateral ischaemic events was 5.7%. The annual ipsilateral ischaemic event risk was 1.8% in patients with good VMRs, whilst it was 7.1% in patients with impaired VMRs. An impaired VMR was significantly correlated with ipsilateral IS (Kaplan–Meier log rank statistic, P = 0.04). Conclusions: Our results support the value of VMR assessment for identifying asymptomatic patients with carotid occlusion who belong to a high‐risk subgroup for IS. New trials using extracranial‐to‐intracranial bypass surgery in patients with asymptomatic ICA occlusion and impaired VMRs are warranted.     

Assessment of the cerebral vasomotor reactivity in internal carotid artery occlusion using a transcranial Doppler sonography and functional MRI.

BACKGROUND AND PURPOSE: Several methods are being used to assess cerebral vasomotor reactivity (CVR), including transcranial Doppler (TCD) sonography and blood oxygenation level-dependent functional magnetic resonance imaging (fMRI). The aim was to assess the correlation of TCD and fMRI in the CVR assessment. METHODS: Study group consisted of 28 patients (24 males, 4 females; aged 30-82, mean 63.1 +/- 10.0 years), presenting with 29 occluded internal carotid arteries. The TCD examination, including breath-holding/hyperventilation test (BH/HV) and breath-holding index (BHI), and fMRI examination were used for the assessment of CVR. fMRI employed a bimanual motor task within both a block paradigm and an event-related paradigm. Cohen's kappa was applied when statistically assessing correlation of the methods. RESULTS: The following correlations were found--between BH/HV and BHI 58.6%, kappa= .205; BH/HV and fMRI 65.5%, kappa= .322; BHI and fMRI 58.6%, kappa= .151; TCD (consistent result of both BH/HV and BHI test) and fMRI 70.6%, kappa= .414. CONCLUSIONS: In the evaluation of CVR, there is only a minimal correlation between the particular TCD tests (both BH/HV and BHI), and fMRI examination. However, there is a moderate correlation between TCD and fMRI in the case of congruity of both TCD tests.     

Cerebral vasomotor reactivity of the posterior circulation in patients with carotid occlusive disease

We evaluated the hemodynamic features of the posterior circulation in patients with severe carotid stenosis by assessing and comparing cerebral vasomotor reactivity (VMR) in the middle cerebral (MCA) and vertebral arteries (VA) by transcranial Doppler and the Diamox (1 g acetazolamide i.v.) test. Sixty symptomatic and 111 asymptomatic patients with unilateral severe (>70%) internal carotid artery stenosis were studied. The VMR was 19.2 +/- 18.9% for the MCA ipsilateral to the stenosis and 27.3 +/- 17.4% on the contralateral side (P < 0.0001) for all patients. It was 18.2 +/- 23.2% for the VA ipsilateral to the stenosis and 19.7 +/- 21% on the contralateral side (P = NS). The symptomatic patients' VMR of the MCA on the side of stenosis and the opposite side were 19.2 +/- 17.6 and 29 +/- 17.2%, respectively (P < 0.03). The VMR of the VA remained similar (15.1 +/- 21 and 21.6 +/- 6%, respectively, P = NS). The asymptomatic patients' VMR of the MCA on the side of the stenosis was also lower (19.2 +/- 19.7 vs. 26.5 +/- 17.5% on the opposite side, P < 0.001). In contrast, the VMR in the VA was similar (19.8 +/- 21.4 and 18.7 +/- 19.5%, respectively, P < 0.6, NS). Thus, the VMR of the posterior circulation remained similar regardless of carotid stenosis and a symptomatic/asymptomatic course of carotid occlusive disease, suggesting an independent cerebral vascular reserve capacity of the posterior circulation.     

Cerebral vasomotor reactivity of bilateral severe carotid stenosis: is stroke unavoidable?

We evaluated the cerebral hemodynamic features of severe bilateral carotid stenosis by assessing and comparing cerebral vasomotor reactivity (VMR) in the middle cerebral (MCA) and vertebral arteries (VA) by transcranial Doppler and the Diamox (1 g acetazolamide i.v.) test. VMR was evaluated by recording the percentage differences in peak systolic blood flow velocity in each MCA and VA at baseline and by the Diamox test. Twenty-eight symptomatic (SCAS) and 31 asymptomatic (ACAS) patients with bilateral severe (>70%) internal carotid artery stenosis were studied. The mean MCA VMR% was 29 +/- 26.9% in SCAS and 43.2 +/- 26.8% in ACAS patients (P < 0.01). Their respective mean VA VMR% was 30.2 +/- 36.5% and 39.6 +/- 24.4% (P = NS). VMR% of the symptomatic MCA side in SCAS patients was significantly lower than the opposite side (20.5 +/- 31.1% and 39.2 +/- 37.9% respectively; P < 0.03). In contrast, the VA VMR% of both sides in SCAS patients remained similar (28.1 +/- 39.3% and 34.6 +/- 47.9% respectively; P = NS). VMR% of the MCA and VA in ACAS patients was also similar for both sides of bilateral carotid stenosis. The cerebral hemodynamic features differ between SCAS and ACAS patients with bilateral carotid occlusive disease in the anterior part of the circle of Willis. An independent cerebral vascular reserve capacity of the posterior circulation is proposed.     

Source of cerebral microembolic signals in occlusion of the internal carotid artery

Background and purpose: There are several possible sources of cerebral embolic ischaemia distal to an occlusion of the internal carotid artery (ICA). Our aim was to identify the source of microembolic signals in the ipsilateral middle cerebral artery (MCA) by taking simultaneous bitemporal transcranial Doppler ultrasound recordings of the ipsilateral MCA and the contralateral ACA to find the route of potential microembolic material to MCA. Subjects and methods: The study group consisted of 38 patients with an occlusion of the ICA. With extracranial duplex sonography (ACUSON 128 XP; 7 MHz), performed by an experienced sonographer, the echo intensity and echo structure of the occluded ICA in the extracranial part (proximal) were classified as homogeneous or inhomogeneous. In addition, affected segments of the ipsilateral and contralateral carotid artery with arteriosclerotic vessel walls were compared. Microembolic signals were recorded with transcranial Doppler (TCD) monitoring. The microemboli counts in the MCA and ACA were added to the sum scores. Results: The number of affected segments of the carotid artery on the ipsilateral (the bifurcation, the external or common carotid artery) and contralateral side of occluded ICA were equally distributed. In ipsilateral MCA 3.1, 7.1 microemboli (average mean, SD) with a range of between 0 and 34 were counted, in the contralateral ACA 0.3, 0.6 (range of between 0 and 2). Regression analysis confirmed the non-predictability of the microemboli variance on the ipsilateral side of the occlusion from the variance on the contralateral side (multiple r: 0.024). We found no significant correlation between the echo intensity or echo structure of the occluded artery and an increased rate of microemboli in the ipsilateral MCA. Conclusions: Our results indicate a predominantly ipsilateral source for cerebral microemboli in ICA occlusion. The rate of cerebral microembolic signals was not influenced by the echo structure and echo intensity of the occluded ICA. Received: 24 May 1996 Received in revised form: 20 January 1997 Accepted: 31 January 1997     

Carbon dioxide reactivity and patterns of cerebral infarction in patients with carotid artery occlusion

Summary A total of 106 patients with 112 internal carotid artery occlusions were investigated by cranial computed tomography and transcranial Doppler ultrasonography (CO₂ test), giving a measure of the cerebrovascular reserve capacity. The morphological patterns of the ischaemic lesions were classified into three categories: lacunar, thromboembolic and haemodynamic infarctions. Of 29 patients with an exhausted CO₂ reactivity, 19 showed a haemodynamic type of infarction, whereas of 45 cases with a normal CO₂ reactivity only 2, and of 38 patients with a diminished CO₂ reactivity only 3 had haemodynamically caused infarctions (P<0.001). The correlation between an exhausted CO₂ reactivity and the presence of haemodynamic infarctions could be of value for therapy in patients with carotid artery occlusions.     

TCD诊断颈内动脉严重狭窄或闭塞的临床意义

目的经颅多普勒超声（ＴＣＤ）检测脑循环障碍的实用价值。方法用ＴＣＤ检测１６例一侧颈内动脉（ＩＣＡ）颅外段严重狭窄或闭塞患者。结果发现这些患者脑血流动力学均有明显改变，１４例存在侧枝循环，其中１０例以前交通动脉为主，４例后交通动脉参与，且有７例眼动脉同时参与，２例未见侧枝循环。侧枝循环良好的患者，患侧大脑中动脉的平均血流速（ＭＣＡＶｍ）为５０．３±６．２ｃｍ／ｓ；侧枝循环较差的患者，患侧ＭＣＡＶｍ为４３±６．８ｃｍ／ｓ。随访发现，侧枝循环良好者，无临床症状或症状轻微；侧枝循环较差者，发生缺血性中风的机率明显增加。结论ＴＣＤ可准确诊断颈内动脉狭窄或闭塞，判断侧枝循环的建立情况，对脑循环作出全面客观的评价。     

Persistence of isolated flow in the internal carotid artery in brain death

The criteria for the confirmation of brain death (BD) using transcranial Doppler ultrasonography (TCD) state that flow should not be observed in the internal carotid artery (ICA). In 94 brain-dead patients examined by TCD, 19 (20%) had flow in the ICA despite cerebral circulatory arrest. There was no difference in the clinical characteristics of patients with or without isolated flow in the ICA. Shunting of blood from the ICA into the external carotid system or the arrest of blood flow at a higher level than the carotid siphon may explain our findings. Our results show that the current TCD criteria can result in a high rate of false negatives. We suggest that the TCD criteria for the diagnosis of brain death should be reviewed.     

Correlation between the flow pattern of the circle of Willis and segmental perfusion asymmetry after carotid artery revascularization

Background: To correlate cerebral perfusion and flow patterns after carotid artery revascularization within the circle of Willis (CoW). Methods: Sixty‐five patients (male/female ratio: 38/27; mean age: 63.2 ± 8.4 years; range: 44–82 years) with symptomatic carotid artery stenosis underwent magnetic resonance (MR) angiography and perfusion imaging prior to and after carotid artery stenting (CAS). Regions of interest (ROIs) on the MR perfusion maps included the corona radiata (CR), centrum semiovale (CSO), occipital region (O), and basal ganglia region (BA) in both stented and non‐stented hemispheres. The non‐stented hemisphere was used as internal control. Results: Subjects were assigned to the altered CoW group (N = 31) vs. the static CoW group (N = 34). Thirty‐one subjects (47.6%) had an altered flow pattern in the CoW after CAS, and thirty‐four (52.4%) retained a static CoW configuration. Relative cerebral blood volume (rCBV) interhemispheric index correlated with CoW morphologic alterations after carotid stenting. Altered CoW group had a higher regional interhemispheric index of rCBV in the CR (1.23 ± 0.15 vs. 0.87 ± 0.13; P = 0.03) and basal ganglia (1.25 ± 0.12 vs. 0.91 ± 0.11; P = 0.03) compared to the static group. Conclusions: An association between the regional cerebral blood volume (rCBV) interhemispheric asymmetry and CoW collateralization was observed. In addition, the CR, rather than CSO, was found to have topographic significance.     

A longitudinal study of collateral flow patterns in the circle of Willis and the ophthalmic artery in patients with a symptomatic internal carotid artery occlusion

BACKGROUND AND PURPOSE: The purpose of the present study was to assess whether the direction of flow via the circle of Willis and the ophthalmic artery (OphA) changed over time in patients with a symptomatic occlusion of the internal carotid artery (ICA) who did not experience recurrent cerebral ischemic symptoms. METHODS: Sixty-two patients with a symptomatic ICA occlusion were investigated within 6 months after symptoms occurred. The investigations were repeated after 6 and 12 months. The directions of flow in the A1 segment and the posterior communicating artery (PCoA), both on the side of the symptomatic ICA occlusion, were assessed with the use of magnetic resonance angiography. The pattern of collateral flow via the circle of Willis was categorized as via the A1 segment only, via the PCoA only, via the A1 segment plus the PCoA, or no collateral flow via the circle of Willis. The direction of flow in the OphA was investigated with transcranial Doppler sonography. CO(2) reactivity was determined with transcranial Doppler sonography to investigate whether changes in flow patterns were accompanied by changes in cerebrovascular reactivity. RESULTS: There were no statistically significant changes over time in the direction of blood flow in the A1 segment and the PCoA or in the pattern of collateral flow via the circle of Willis. On average, 72% of patients with a unilateral ICA occlusion (n=41) had willisian collateral flow compared with 37% of patients with a bilateral ICA occlusion (n=21; P<0.05). Patients with a unilateral ICA occlusion tended to a lower prevalence of reversed flow via the OphA over time. CO(2) reactivity did not change significantly in any patient group. In patients with a unilateral ICA occlusion, decreased CO(2) reactivity was associated with a higher prevalence of absent willisian collateral flow and a lower prevalence of collateral flow via the A1 segment plus the PCoA. CONCLUSIONS: The absence of recurrent cerebral ischemic symptoms in patients with a symptomatic ICA occlusion is not associated with an improvement in collateral flow via the circle of Willis or the OphA during 1.5-year follow-up.     

眼动脉段动脉瘤的手术治疗(附40例报告)

目的 探讨颈内动脉眼动脉段动脉瘤的临床特点及显微手术的治疗方法.方法 回顾性分析我院2006年12月至2010年9月40例颈内动脉眼动脉段动脉瘤患者的临床资料.男13例,女27例,其中合并前交通动脉瘤1例,双侧颈内动脉眼动脉段动脉瘤4例,合并后交通动脉瘤4例,合并小脑后下动脉瘤1例,合并大脑中动脉瘤1例,合并基底动脉瘤1例.结果 按GOS评分评定手术患者预后,恢复良好33例,轻度残疾1例,重度残疾2例,死亡4例;术后随访2 - 46个月(平均21.3个月),行头颅CTA或DSA检查证实动脉瘤夹闭完全.结论 经翼点入路夹闭颈内动脉眼动脉段动脉瘤是一种安全有效的方法.应根据患者术前Hunt - Hess分级以及动脉瘤的部位、大小、形态和医院的设备条件,选择个体化的治疗方法,术前完善影像学检查及手术过程中应用微血管多普勒对减少术后并发症及改善预后有重要意义.     

经颅多普勒超声评估单侧颈内动脉颅外段闭塞患者颅内侧支循环的临床意义

目的 探讨经颅多普勒超声(TCD)评估单侧颈内动脉颅外段闭塞(ICAO)患者颅内侧支循环的临床价值.方法 回顾性连续纳入2018年1月至2020年12月就诊于苏州大学附属第一医院卒中中心、行颈部血管超声检查为单侧ICAO及数字减影血管造影(DSA)证实患者145例,其中症状组109例,无症状组36例.记录TCD评估颅内...     

老年人脑萎缩与颈内动脉虹吸部钙化积分的相关性研究

目的探讨老年人脑萎缩与颈内动脉虹吸部钙化积分的相关性。方法对327例老年人进行颅脑CT检查,观察脑萎缩的发生情况,测定并计算颈内动脉虹吸部钙化积分。根据钙化积分将其分为钙化0分组、钙化1~199分组、钙化200~399分组、钙化400~599分组及钙化≥600分组。比较各组脑萎缩情况,并分析钙化积分与脑萎缩的关系。结果根据颈内动脉虹吸部钙化积分分组,钙化0分组63例,钙化1~199分组133例,钙化200~399分组72例,钙化400~599分组28例,钙化≥600分组31例。钙化0分组中有脑萎缩13例(20.63%),钙化1~199分组中有脑萎缩64例(48.12%),钙化200~399分组中有脑萎缩51例(70.83%),钙化400~599分组中有脑萎缩23例(82.14%),钙化≥600分组中有脑萎缩28例(90.32%);各组间脑萎缩患病率的比较差异有统计学意义(均P0.05)。钙化0分组及钙化1~199分组脑萎缩以轻-中度为主;钙化200~399分组脑萎缩以重度为主;钙化400~599分组及钙化≥600分组脑萎缩以中-重度为主(均P0.05)。Spearman等级相关分析显示,脑萎缩程度与颈内动脉虹吸部钙化积分分值呈正相关(r=0.717,P0.05)。结论老年人脑萎缩与颈内动脉虹吸部钙化积分显著相关,钙化积分越大,脑萎缩的患病率越高,程度越重。颈内动脉虹吸部钙化积分可以作为预测老年人罹患脑萎缩的一项重要指标。     

Diagnostic criteria for transcranial colour-coded duplex sonography evaluation of cross-flow through the circle of Willis in unilateral obstructive carotid artery disease

A transcranial colourcoded duplex sonography (TCCD) study was performed to establish reliable criteria for the assessment of collateral flow through the anterior (ACoA) and posterior (PCoA) communicating artery without using compression tests. We studied 86 patients with angiographically evaluated unilateral > 69% stenosis (n = 53) and occlusion (n = 33) of the carotid artery. The following TCCD criteria were evaluated: for diagnosis of cross-flow through the ACoA, detection of reversed flow in the anterior cerebral artery (ACA) on the obstructed (ipsilateral) side. For the diagnosis of cross-flow through the PCoA: (A) identification of the PCoA; (B) peak systolic velocity in P1 posterior cerebral artery (PCA) higher than the mean value + 2 SD of normals; (C) ratio of ipsilateral peak systolic P1 PCA velocity to peak systolic P2 PCA velocity higher than the mean ratio + 2 SD of normals; (D) ratio of ipsilateral peak systolic PI PCA velocity to contralateral peak systolic P1 PCA velocity higher than the mean ratio – 2 SD of normals; (E) peak systolic basilar artery velocity higher than the mean value + 2 SD of normals. Eight patients (9%) with inadequate temporal ultrasonic windows were excluded. The sensitivity and specificity for TCCD evaluation of ACoA crossflow were 100%. Using criteria A and B the corresponding values for the PCoA were 85 and 98%, respectively. Criteria C-E were not useful owing to lower sensitivity. In conclusion, we delineated TCCD criteria that make it possible to assess reliably the cross-flow through the circle of Willis in patients with adequate ultrasonic windows.     

眼动脉血管反应性在2型糖尿病患者脑血管病变中的诊断价值

目的 评估眼动脉血管反应性在2型糖尿病脑血管病变中的临床诊断价值.方法 运用经颅多普勒诊断仪,对27例2型糖尿病患者和23例健康体检者行TCD检查,对比分析两组人群大脑中动脉(MCA)及眼动脉(OA)的平均血流速度(Vm)、搏动指数(PI)、屏气指数(BHI)的差异程度.结果 糖尿病组与对照组比较,OA的平均血流速度(Vm)、屏气后的平均血流速度(Vm’)、屏气指数(BHI)均降低,与对照组比较均有统计学意义;糖尿病组与对照组比较,MCA的搏动指数(PI)、屏气后的搏动指数(PI’)均增高,与对照组比较均有统计学意义.结论 糖尿病患者MCA、OA的脑血管反应性检测,能早期识别2型糖尿病大血管和微血管病变,为2型糖尿病患者早期及时提供防治依据.     

经颅多普勒联合CT灌注成像对单侧颈内动脉重度狭窄或闭塞患者脑血流动力学评价

目的 经颅多普勒(TCD)联合CT灌注成像(CrP)对单侧颈内动脉(ICA)重度狭窄或闭塞患者脑血流动力学评价.方法 经TCD检测为单侧ICA重度狭窄或闭塞患者19例,分症状组(9例)及无症状组(10例),行头颅CT血管成像(CTA)和CTP检查.15例健康志愿者为对照组.比较症状组和无症状组患侧之间、症状组和无症状组患侧与对照组TCD及CTP参数.结果 TCD示症状组患侧大脑中动脉(MCA)平均血流速度(Vm)低于对照组(P＜0.001),而无症状组MCA Vm低于对照组,但差异无统计学意义(P＞0.05);症状组和无症状组MCA搏动指数(PI)均低于对照组(P＜0.05).症状组患侧MCA Vm明显低于无症状组(P ＜0.001),与颅内侧枝循环有关.症状组和无症状组与对照组CTP参数分析,症状组患侧脑血流量(CBF)减低(P＜0.05),而无症状组CBF无明显改变(P＞0.05);症状组和无症状组平均通过时间(MTI)及达峰时间(TIP)延长(P＜0.05),但两组脑血容量(CBV)与对照组比较差异无统计学意义(P＞0.05).结论 TCD与CTP结果有良好的一致性,二者联合应用可以综合评估单侧颈动脉狭窄或闭塞患者脑灌注情况,为临床选择有效治疗方案提供科学依据.     

Long term follow-up of unilateral occlusion of the internal carotid artery including repeated tests of vasomotor reactivity by transcranial Doppler

BACKGROUND: Early study on pathological flow pattern in the ophthalmic artery (OA), connected with impaired vasomotor reactivity (VMR) and low pulsatility index (PI) in the anterior cerebral artery (ACA) on the occluded side, suggested collateral exhaustion. We undertook this study to evaluate whether the occurence of new strokes is predicted by special haemodynamic features.METHOD: A total of 27 patients (22 men and five women), aged 63+/-15 years (mean+/-SD) with longstanding occlusion of the internal carotid artery (ICA), confirmed by duplex scanning were studied. They had minimal neurological deficit and were followed-up for mean 4.3+/-1.8 (mean+/-SD) years by repeated clinical and 3-D transcranial Doppler (3-D TCD) examinations with azetazolamide test of vasomotor reactivity (VMR).RESULTS: During follow-up, seven patients had new strokes (five minor strokes and two major ones), two ipsilateral and four contralateral to the ICA occlusion and one in the posterior circulation. Four patients died, All patients experiencing a new stroke had previous symptoms and pathological flow patterns in the OA, i.e retrograde or isoelectric flow were noted in six of them. One patient with contralateral stroke experienced occlusion of the ICA located above the origin of the OA with anterograde flow; otherwise none of 11 patients with anterograde flow had a new stroke (p<0.05, Fisher exact text). During the follow-up, the initial mean velocity (MV) in the middle cerebral artery (MCA) on the occluded side in six patients with a new stroke in the anterior circulation, was 26.83+/-10.50 cm/s, which was significantly different from that of patients without a new stroke (45.80+/-12.8 cm/s) (p<0.01). MV in the ICA on the non-occluded side at the last examination was greater than that at the first examination (p<0.05) and increased after the use of acetazolamide only on this side (p<0.05), while PI decreased bilateraly (p<0.001 and 0.05). Resting MV both in the MCA on the occluded and ACA on the non-occluded side slightly decreased, while MV in the posterior cerebral artery (PCA) increased on the occluded side (p<0.083) compared with that at the start of the follow-up. VMR in the ACA decreased slightly both on the non-occluded and occluded side (Delta-6.9 and Delta-5.3 respectively), while impaired VMR相似文献   

Spect measurements of regional cerebral perfusion and carbondioxide reactivity: Correlation with cerebral collaterals in internal carotid artery occlusive disease

Background The aim of the present study was to assess the regional variation in cerebral perfusion, vasomotor reactivity (VMR) and the role of cerebral collaterals in patients with symptomatic internal carotid artery (ICA). Methods Seventeen functionally independent patients (60±9 years, mean±SD) with a unilateral symptomatic internal carotid artery occlusion and a <30% contralateral ICA stenosis were investigated. (99 m) Tc-hexamethyl propyleneamine oxime (HMPAO) single photon emission computed tomography (SPECT) was performed to study cerebral blood flow in rest and during a CO₂ challenge in the cerebellum, temporal lobe, occipital lobe, basal ganglia, frontal lobe and parietal lobe. Time of flight and phase contrast MRA were used to study collateral flow via circle of Willis. Results In rest, cerebral perfusion on the side ipsilateral to the ICA occlusion was decreased compared with the contralateral side in the basal ganglia (p<0.05), frontal lobe (p<0.01) and parietal lobe (p<0.01). During a CO₂ challenge only the ipsilateral frontal lobe demonstrated a perfusion decrease compared with the contralateral frontal lobe (p<0.05). Furthermore, in patients without collateral flow via the anterior circle of Willis the perfusion of the ipsilateral frontal lobe was significantly decreased (p<0.01) during the CO₂ challenge and crossed cerebellar diaschisis with a decreased perfusion on the contralateral cerebellar hemisphere was detected (p<0.05). No cerebral blood flow (CBF) differences were found for present/absent collateral flow via the posterior communicating artery. Conclusion Regional assessment of cerebral perfusion and VMR with SPECT demonstrated the heterogeneity of cerebral hemodynamics and the importance of collateral flow via the anterior circle of Willis. Received in revised form: 22 November 2005     

症状性颈内动脉眼段闭塞非急性期介入开通治疗的临床研究

目的探讨介入开通治疗症状性颈内动脉眼段非急性期闭塞的有效性和可行性,初步分析疗效影响因素。方法选取河南省人民医院脑血管介入科自2013年1月至2017年12月收治的54例颈内动脉眼段非急性期闭塞患者作为研究对象,所有患者均在全麻状态下行闭塞血管介入开通治疗。记录患者治疗前后改良Rankin量表(mRS)评分、美国国立卫生研究院卒中量表(NIHSS)评分,以及随访2年后预后情况。通过Logistic回归分析明确影响预后的独立因素。结果54例患者中52例开通成功,2例未成功。治疗前mRS评分为(2.25±0.13)分,NIHSS评分为(18.43±1.36)分;治疗后评分显著下降,分别为(1.44±0.05)分、(11.81±0.71)分,差异有统计学意义(P<0.05)。随访2年,52例患者预后良好42例,预后不良8例,2例失访。多因素Logistic回归分析显示,高血压史(OR=1.429,95%CI:1.146~1.783,P=0.005)、糖尿病史(OR=2.597,95%CI:2.364~2.854,P=0.005)是影响介入开通治疗颈内动脉眼段非急性期闭塞患者预后的独立危险因素。结论介入开通治疗症状性颈内动脉眼段非急性期闭塞疗效可靠,高血压史、糖尿病史可影响患者预后。