TCD对颈内动脉中度及重度狭窄患者脑血流动力学的评估价值

目的应用经颅多普勒超声(transcranial doppler,TCD)评价颈内动脉中度及重度狭窄患者的脑血流动力学变化。方法经数字减影血管造影(digital subtraction angiography,DSA)确诊单侧颈内动脉中度及重度狭窄的患者69例,采用TCD检测其大脑中动脉血流参数,评价其侧支循环开放情况和脑血流储备能力(CRV)。结果 TCD显示侧支循环开放者患侧收缩期峰时血流速度(Vs)、搏动指数(PI)及CVR明显高于无侧支循环开放患者(P0.05),颈内动脉中度狭窄组患侧收缩期峰时血流速度(Vs)、PI值及CVR明显高于重度组(P0.05)。结论颈内动脉狭窄时侧支开放可以改善远端血流动力学指标,但改善程度有限。TCD可检测颈内动脉狭窄患者颅内血流动力学变化,评价颅内侧支循环的建立情况,为临床治疗和评估提供可靠依据。     

Multimodal tests of cerebrovascular reactivity in migraine: a transcranial Doppler study

Summary Altered cerebral vasoreactivity (CVR) has been implicated in migraine. To test this hypothesis, we studied CVR as measured by transcranial Doppler ultrasound (TCD) in 11 migraineurs and 12 healthy controls of similar age. Mean flow velocities (MFV) in the middle cerebral artery (MCA) were recorded during a cognitive and two motor tasks. MFV in the posterior cerebral artery (PCA) were measured during photic stimulation and observation of complex images. The increase of MFV in the MCA during the cognitive task was greater in migraineurs than in controls (9.1% vs 5.0% ;P = 0.06). The increase of MFV in both tests for PCA reactivity was significantly greater in migraineurs than in controls: 17.4% vs 9.9% for photic stimulation (P < 0.05) and 20.3% vs 10.2% for observation of complex images (P<0.05). Owing to overlap of individual results, the discriminative value of both tests was unsatisfactory. The variability of flow velocities as measured by standard deviations of MFV was significantly greater in migraineurs than in controls during all tests of PCA vasoreactivity. Differences in CVR between migraineurs and normal controls may be detected by TCD testing, in particular in the PCA territory. For individual diagnostic purposes, CVR tests proved to be insufficient.     

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...     

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.     

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。     

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     

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.

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.     

Vascular reactivity in middle cerebral artery and basilar artery by transcranial Doppler in normals subjects during hypoxia

The anatomical and physiological differences between the carotid and vertebrobasilar circulations suggest the possibility of a different response to variations in systemic pO₂.We evaluated cerebrovascular response (CR) in these two systems by monitoring variations in the blood flow velocities in the middle cerebral and basilar arteries during hypoxia.Eighteen healthy, non-smoking volunteers underwent transcranial Doppler study during a state of hypoxia obtained by means of the rebreathing method. Oxyhaemoglobin saturation (SaO₂) was monitored using a pulsoxymeter in the 88–94% range. The cerebral blood flow velocity (BFV) was measured in the right middle cerebral artery (MCA) and the basilar artery (BA).Our findings indicate that the mean blood flow velocity (MFV) in the BA changes at a lower rate than that in the MCA during hypoxia.

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Sommario Le differenze anatomiche e funzionali tra la circolazione carotidea e vertebrobasilare suggeriscono la possibilità di una diversa risposta alle variazioni della PaO₂ sistemica.Abbiamo valutato la risposta cerebrovascolare in questi due sistemi monitorando le variazioni della velocità di flusso ematico nell'arteria cerebrale media e nell'arteria basilare durante ipossia. Diciotto volontari sani, non fumatori, sono stati sottoposti a studio Doppler Transcraniale durante ipossia ottenuta con il metodo del rebreathing. La saturazione della ossiemoglobina (SaO₂) è stata monitorata con un pulsossimetro (Minolta Pulsox 7) con un ambito di variazione da 88 a 94%. La velocità del flusso ematico cerebrale è stata misurata nell'arteria cerebrale media e nell'arteria basilare. I nostri risultati indicano che, durante l'ipossia, la velocità media del flusso ematico si modifica in misura minore nell'arteria basilare che nell'arteria cerebrale media.

     

单侧颈动脉阻塞性病变时侧支循环募集的特征分析

目的以数字减影血管造影为检查方法,分析单侧颈动脉阻塞性病变时侧支循环的募集特征。方法选择2007年1月～2011年11月北京大学首钢医院神经科DSA检查患者336例,观察每位患者的颈动脉及颅内动脉狭窄程度、Willis环组成及其他侧支循环出现情况。结果 (1)颈动脉狭窄程度与COW各段的完整性均不相关。(2)颈动脉狭窄率≤85%者均未见有代偿侧支。颈动脉86%～99%狭窄者85.7%患者代偿侧支有ACOA和PCA经软脑膜动脉通路,未见PCOA和OA通路;闭塞组则4条通路都有开放,最多是ACOA通路(92.3%),其次是PCA和OA通路(46.2%)。就代偿程度而言,ACOA通路代偿较充分,级别较高。(3)相关分析显示,各代偿通路开放与否及代偿程度均与颈动脉狭窄程度相关,其中ACOA通路、总的侧支通路数和代偿级别与之重度相关。结论 Willis环各段不因颈动脉狭窄程度的发展而改变;侧支循环只出现于颈动脉≥86%狭窄者,各侧支通路开放与否及侧支代偿程度均与颈动脉狭窄程度相关;单侧颈动脉狭窄后,ACOA是最重要的侧支通路。     

Intracerebral steal phenomenon in symptomatic carotid artery disease

Background and purpose

Intracerebral steal is a paradoxical vasodilatory response that reduces cerebral blood flow (CBF) in hemodynamically compromised brain tissue when blood is rerouted to more healthy areas. The aim of our study was to investigate the presence and extent of steal in patients with steno-occlusive internal carotid artery (ICA) disease, and to assess its relation with collateral blood flow through the circle of Willis (CoW).

Microembolization from a carotid mural thrombus detected by transcranial Doppler

Over the last few years, many authors have described the possibility of using transcranial Doppler to demonstrate the passage of microemboli in the cerebral arteries. We report the case of a 44-year-old woman with thrombotic diathesis and thrombocytosis who was admitted twice within a short period of time (one and a half months) to a neurological department because of multiple cerebral infarctions. On the occasion of the second admission, a colour-Doppler examination of the epiaortic vessels, which had previously been negative, showed a carotid lesion due to a mural thrombus and, on the same side as the carotid lesion, transcranial Doppler detected short-duration, high-intensity signals in the middle and anterior cerebral arteries, an expression of the passage of microemboli.As already described by other authors in similar clinical situations, our case confirms that transcranial Doppler can identify the passage of microemboli in the circle of Willis.

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Sommario Negli ultimi anni è stata descritta da molti autori la possibilità di dimostrare mediante Doppler transcranico il passaggio di microemboli nelle arterie cerebrali. Riportiamo il caso di una donna di 44 anni con diatesi trombotica e trombocitosi ricoverata per due volte, a breve distanza di tempo (un mese e mezzo), in ambiente neurologico per infarti cerebrali multipli. In occasione del secondo ricovero l'esame Color-Doppler dei vasi epiaortici, che era risultato negativo in precedenza, ha evidenziato una lesione carotidea riferibile a un trombo murale e al Doppler transcranico sono stati rilevati, omolateralmente alla lesione carotidea, segnali di breve durata ed alta intensità nelle arterie cerebrali media e anteriore, espressione di passaggio di microemboli.Come già descritto da alcuni autori in situazioni cliniche simili, il nostro caso conferma la possibilità di individuare, mediante Doppler transcranico, il passaggio di microemboli nel circolo cerebrale.

     

Cerebrovascular CO2 reactivity in migraine: assessment by transcranial Doppler ultrasound

Summary Cerebrovascular reactivity to CO₂ inhalation was studied by transcranial Doppler sonography in 30 patients with classic or common migraine and 39 healthy controls without clinical or ultrasonic signs of arteriosclerosis. Systolic and diastolic Doppler frequencies of the middle cerebral artery were plotted against end-tidal CO₂ partial pressure; the reactivity index (I×R) was defined as relative frequency change during a PCO₂ increase of 5 mm Hg. In the normal subjects, I×R was 20.0±6.3 for systolic velocities, and 26.0±8.2 for diastolic values. Migraineurs during their headache-free interval had significantly higher I×R values on the affected side (mean: 41.6 systolic, 61.2 diastolic), compared with either controls (P<0.01) or the contralateral side (mean: 28.3 systolic, 30.8 diastolic; P<0.01). During the headache attack, CO₂ reactivity was significantly lower than normal only for systolic velocities (mean: 8.3; P<0.05). Increased CO₂ reactivity is thought to be one phenomenon of migraine. Transcranial Doppler CO₂ testing of cerebrovascular reactivity is a reliable method that may be of interest for the diagnostic evaluation and management of migraine patients.     

症状性急性颈内动脉不同部位闭塞侧支循环的临床研究

目的研究颈内动脉不同部位闭塞后侧支循环的特征及临床和影像表现。方法用DSA研究颈内动脉急性闭塞后侧支的形成。选择DSA确诊的颈内动脉闭塞者48例,颈内动脉颈段闭塞28例,颈内动脉脑段闭塞20例。对比两组病例侧支方式及临床和影像表现。用NIHSSS评价发病7d时神经功能状况。头部CT/MRI显示的梗死面积用(A·B·C)/2计算。结果颈内动脉颈段闭塞组前交通动脉出现率和后交通动脉出现率及眼动脉出现率,开放侧支途径≥2条,高于颈内动脉脑段闭塞组(P<0.05)。软脑膜吻合支出现率在两组间无统计学差异。颈内动脉颈段闭塞组7d时NIHSSS≤8分的患者比颈内动脉脑段闭塞组多(P<0.05),梗死面积小(P<0.05)。结论颈内动脉不同部位闭塞的侧支方式不同,脑内侧支的多少和范围决定了梗死的大小和全面的诊断。     

轻度认知障碍患者的经颅多普勒屏气试验临床研究

目的应用经颅多普勒（TCD）进行屏气试验检测,观察轻度认知障碍（MCI）患者的脑血管反应性（CVR）特点。方法180例受试者编入正常对照组、MCI组及阿尔茨海默病（Alzheimerdis—ease,AD）,分析屏气指数（BHI）与认知功能及脑血流动力学指标的关系。结果MCI组与正常组及AD组比较,BHI结果有统计学意义（P〈0．01）;BHI与视觉ERP的P300潜伏期的相关性最强（r=0．411,P〈0．001）;MCI组不同CVR状态下,各组受试者脑动脉硬化及血管狭窄检出率有差异,事件相关电位（ERP）和TCD常规检测指标比较有统计学意义（P〈0．05）。结论BHI的改变与MCI患者的认知功能损害密切相关,CVR检测有助于MCI的病因诊断。     

Diagnosis of carotid artery disease – comparison between directional Doppler, Duplex scanner and angiography

Examinations with directional Doppler (DD) with 10 MHz transducer, and pulsed Doppler in combination with two-dimensional sector scanner with 3 MHz transducer (Duplex) were carried out on 100 vessels in 51 patients with transitory ischemic attacks (TIA) and minor stroke within the territory of the internal carotid artery before angiography. The question at issue was to evaluate the accuracy of both methods in discriminating between occlusion and stenosis. A correct diagnosis was made by DD in 92 vessels out of 100 and by Duplex in 98 out of 100. All nine occlusions were correctly diagnosed by Duplex, but only five of them by DD, while the four remaining vessels were considered as stenosis > 50%. Out of 15 stenoses > 50%, 14 were correctly detected by Duplex and 11 by DD. One patient with tortuous vessel without stenosis was classified as > 50% stenosis by Duplex, and one vessel with 1 mm lumen was called occlusion by Duplex and DD. In conclusion, the Duplex scanner offers increased possibility to differ between high-grade stenosis and occlusion of the carotid arteries as compared with earlier non-invasive techniques.     

侧支循环对颈内动脉重度狭窄或闭塞患者脑血管反应性和注意网络的影响

目的探讨侧支循环开放的类型对颈内动脉(internal carotid artery,ICA)重度狭窄或闭塞患者脑血管反应性和注意网络的影响。方法将有侧支循环形成的患者分为前交通动脉(anterior communicating artery,Aco A)开放组、后交通动脉(posterior communicating artery,Pco A)开放组和眼动脉(ophthalmic artery,OA)开放组,分别检测各组的屏气指数(breath-holding index,BHI)和注意网络测试(attention network test,ANT)指标。结果 Aco A开放组患侧BHI、总平均反应时间(reaction time,RT)和执行功能优于其它两组,OA开放组的定向和执行功能较其它两组减退(P0.05)。Aco A和Pco A开放组患侧的BHI与相应的ANT总平均RT呈负相关(P0.01)。结论 Aco A开放患者脑血管反应性和注意网络损害的程度较Pco A和OA开放者较轻,Aco A是对于注意功能最有效的侧支循环。     

颈部血管彩色超声和经颅多普勒超声联合检查评价前循环脑动脉粥样硬化

目的应用颈部血管彩色超声和经颅多普勒超声(TCD)联合检查方法,对急性缺血性脑卒中患者前循环脑动脉粥样硬化的程度进行评价,并讨论其临床意义。方法107例50～85岁急性前循环缺血性脑卒中患者,于发病后2周内完成颈部血管彩色超声及TCD检查。分别记录颈动脉颅外段狭窄组CT/MRI阳性侧和阴性侧颈总动脉/颈内动脉颅外段(CCA/EICA)不同回声斑块、斑块大小以及动脉狭窄程度;前循环颅内血管狭窄组CT/MRI阳性侧和阴性侧颈内动脉虹吸段(SCA)、颈内动脉末段(TICA)、大脑中动脉M1段(MCA-M1)、大脑前动脉A1段(ACA-A1)狭窄程度及双侧颈总动脉/颈内动脉颅外段不同回声斑块检出率;前循环颅内外动脉联合狭窄组CT/MRI阳性侧和阴性侧颈总动脉/颈内动脉颅外段、大脑中动脉M1段及大脑前动脉A1段狭窄程度。结果颈动脉颅外段狭窄组:CT/MRI阳性侧颈总动脉/颈内动脉颅外段和阴性侧比较,不同回声斑块大小及阳性检出率差异无统计学意义(P>0.05);狭窄程度为40%～50%、>50%～70%的颈总动脉/颈内动脉颅外段,两侧狭窄血管阳性检出率差异无统计学意义(P>0.05);当狭窄程度达>70%～90%和>90%时,CT/MRI阳性侧检出率均大于阴性侧(P<0.05)。前循环颅内血管狭窄组:CT/MRI阳性侧颈总动脉/颈内动脉颅外段与阴性侧之间不同回声斑块大小及阳性检出率差异均无统计学意义(P>0.05);颈内动脉虹吸段或颈内动脉末段和大脑中动脉M1段狭窄发生率,CT/MRI阳性侧大于阴性侧(P<0.05);大脑前动脉A1段狭窄发生率两侧差异无统计学意义(P>0.05)。前循环颅内外动脉联合狭窄组:CT/MRI阳性侧颈总动脉/颈内动脉颅外段狭窄程度>70%和大脑中动脉M1段狭窄阳性检出率均大于阴性侧(P<0.05);大脑前动脉A1段狭窄血管两侧阳性检出率差异无统计学意义(P>0.05)。结论同一组脑动脉粥样硬化患者颈动脉粥样硬化进展程度基本相同,根据斑块回声和溃疡形成与否不能确定动脉-动脉栓塞的"责任斑块";颈部血管彩色超声检查提示颈总动脉/颈内动脉颅外段狭窄程度>70%,以及TCD提示颈内动脉虹吸段、颈内动脉末段、大脑中动脉M1段狭窄≥50%者,与同侧脑卒中的发生明显相关,二者联合应用有助于确定急性缺血性脑卒中的"责任动脉"。     

糖尿病与非糖尿病脑梗塞病人的经颅多普勒研究

应用经颅多普勒超声（ＴＣＤ）检测糖尿病脑梗塞ＤＣＩ和非糖尿病脑梗塞（ＮＤＣＩ）各１８例，并与１８例正常对照组进行比较，发现两组病人都以收缩期峰值血流速度（Ｖｐ）的改变为主，ＤＣＩ组的Ｖｐ异常又显著高于ＮＤＣＩ组（Ｐ＜０．０１）。Ｖｐ的改变主要是速度增快，且多伴有血管杂音，可见涡流信号。这些改变以ＭＣＡ和ＣＳ最突出，ＡＣＡ、ＢＡ、ＶＡ和ＰＣＡ均有累及。结果表明ＤＣＩ病人血管损害的范围比ＮＤＣＩ病人广泛得多，可以解释糖尿病病人脑卒中患病率高的原因。     

TCD对小动脉病变为主的腔隙性脑梗死脑血流动力学评价

目的探讨以小动脉病变为主要发病机制的腔隙性脑梗死患者的血流动力学改变。方法利用颈部血管彩超和MRA等排除伴有显著大血管病变的患者后,利用TCD观察115例腔隙性脑梗死患者脑内主要动脉的血流动力学改变,并与年龄和动脉血压等进行相关分析。同时以同年龄阶段、头颅影像学检查正常的30例健康体检者作为对照。结果腔隙性脑梗死组大脑中、前、后动脉的平均血流速度均低于对照组、脉动指数均高于对照组[分别为(1．05±0．26)、(1．01±0．24)、(1．05±0．23)和(0．87±0．12)、(0．88±0．20)、(0．88±0．16),均P＜0．05]。其中大脑中、前、后动脉的脉动指数均与年龄呈正相关(r=0．394、0．299、0．352,均P＜0．05),大脑前动脉脉动指数与收缩压和脉压差呈正相关(r=0．338、0．353,P＜0．05),大脑中动脉脉动指数与脉压差呈正相关(r=0．220,P＜0．05)。结论以小动脉为主要发病机制的腔隙性脑梗死患者脑血流动力学表现为血流速度轻度减慢,脉动指数显著升高,其中脉动指数与年龄和动脉血压有一定的关系。