196例急性脑梗死DWI与MRA分析

目的探讨急性脑梗死的临床表现与DWI(磁共振扩散加权成像)、MRA(磁共振血管成像)之间的相关性。方法对196例急性脑梗死患者行DWI和MRA检查,对其影像学特征进行分析。结果196例患者在DWI病灶均显示为高信号。MRA显示:142例患者发现颅内大动脉狭窄或闭塞,狭窄的动脉分布为大脑中动脉、大脑后动脉、大脑前动脉、三级分支动脉、基底动脉、椎动脉、颈内动脉颅内段。48例腔隙性脑梗死发现血管狭窄或闭塞,且有16例发展成进展性脑梗死,34例腔隙性脑梗死在MRA上未见明显血管狭窄和闭塞,仅1例发生进展性脑梗死。结论急性脑梗死DWI检出阳性率100%,MRA检查最常受累的是大脑中动脉。腔隙性脑梗死病灶所处解剖区的供血大动脉易发生狭窄,且容易出现进展性卒中。     

110例脑梗死患者的全脑数字减影血管造影的临床研究

目的探讨脑梗死患者与颅内-颅外段动脉狭窄或闭塞的关系及其临床意义。方法选择符合脑梗死诊断标准的110例患者行全脑数字减影血管造影(DSA)检查,对颈内动脉系统脑梗死(ICA-CI)和椎-基动脉系统脑梗死(VB-CI)患者的颅内-颅外段动脉狭窄或闭塞进行分析比较。结果 110例脑梗死患者中85例(77.27%)有动脉狭窄或闭塞。其中25例(22.73%)为单纯颅外段动脉狭窄或闭塞,41例(37.27%)为单纯颅内段动脉狭窄或闭塞,19例(17.27%)为颅内-颅外段动脉多发性狭窄或闭塞。DSA共检出动脉狭窄或闭塞173支,颅外动脉段狭窄或闭塞65支(37.57%),颅内段动脉狭窄或闭塞108支(62.43%)。颅内段动脉狭窄或闭塞发生率(62.43%)明显高于颅外段动脉(37.57%)。颅外段动脉狭窄或闭塞的好发部位依次为:颈内动脉颅外段26支(15.03%),椎动脉颅外段19支(10.98%),颈总动脉14支(8.09%),锁骨下动脉6支(3.47%)。颅内段动脉狭窄或闭塞的好发部位依次为:大脑中动脉37支(21.39%),颈内动脉颅内段25支(14.45%),椎动脉颅内段18支(10.40%),大脑后动脉11支(6.36%),大脑前动脉9支(5.20%),基底动脉8支(4.62%)。ICA-CI组单纯颅外段动脉狭窄或闭塞高于VB-CI组(P<0.05),ICA-CI组单纯颅内段动脉狭窄或闭塞高于VB-CI组(P<0.01),ICA-CI组颅内-颅外段动脉多发狭窄或闭塞低于VB-CI组(P<0.05)。ICA-CI组单纯颅内段动脉狭窄或闭塞高于单纯颅外段动脉窄或闭塞,VB-CI组单纯颅内动脉段狭窄或闭塞高于单纯颅外动脉段狭窄或闭塞(P<0.05)。动脉狭窄及粥样硬化斑块与年龄、高血压、低血压、糖尿病、高甘油三酯(TG)、高总胆固醇(TC)、高低密度脂蛋白(LDL-C)、冠心病、肥胖、吸烟、酗洒有密切关系(均P<0.05)。结论 DSA检查有助于脑梗死患者的颅内-颅外段主要供血动脉狭窄与闭塞诊断,对脑梗死的治疗有重要指导作用。     

造影显示的卒中患者颅内外动脉狭窄的分布

目的分析缺血性卒中患者颅内外动脉狭窄的分布.方法收集我院缺血性卒中患者306例,所有患者均进行颈动脉彩超、经颅多普勒超声（TCD）、磁共振血管造影术（MRA）和数字减影血管造影（DSA）检查,狭窄程度按北美症状性颈动脉内膜切除试验（NASCET）测量标准分为5个等级.结果（1）颅内动脉狭窄149例（48.6%）,颅外动脉狭窄25例（8.2%）,颅内外动脉均见狭窄33例（10.8%）;（2）207例动脉狭窄患者中,单支狭窄129例（62.3%）,多支狭窄78例（37.7%）;（3）动脉狭窄的常见部位依次为：大脑中动脉＞椎动脉远端及基底动脉＞颈内动脉颅外段＞大脑前动脉＞大脑后动脉＞颈内动脉虹吸段＞椎动脉起始段;（4）DSA所示狭窄程度：207例316条狭窄血管中,重度狭窄或闭塞87条（27.5%）;（5）157/164例（95.7%）脑卒中病灶与血管狭窄的部位相对应.结论缺血性卒中患者以颅内血管狭窄为多见,大脑中动脉主干狭窄的发生率最高,其次是椎动脉远端及基底动脉.     

大脑中动脉区梗死的DWI特点及与其供血动脉狭窄的关系

目的 探讨大脑中动脉(MCA)区脑梗死磁共振扩散加权成像(DWI)成像病灶分布特点及与其供血动脉狭窄程度的关系.方法 回顾性的分析经颅脑磁共振成像(MRI)的DWI序列诊断的急性脑梗死,选择病灶位于MCA分布区,且完善其供血动脉检查,包括头颈部CTA,或颅脑MRA加颈部血管超声的患者108例,排除心源性栓塞、特殊血管病变导致的脑梗死.将梗死按照部位分为腔隙型梗死(SSSI)、皮层下梗死(SI)和混合型梗死(MI),供血动脉分为正常、轻度(50％)、重度(50％)和闭塞.比较不同类型梗死组的供血动脉狭窄的发生率.结果 各种梗死类型的发生率之间差异无统计学意义(x2=1.08,P＞0.05).单纯MCA病变者53例(53/108,49.1％),单纯ICA病变者28例(28/108,25.9％),单纯MCA病变高于单纯ICA病变(x2=12.35,P＜0.01).同侧血管正常者以LI类型的梗死多见,而单纯ICA病变者以MI类型的梗死多见(x2=10.22;10.54,P＜0.01);三种梗死类型在单纯MCA病变患者中差异无统计学意义(x2=0.25,P＞0.05);在单纯MCA病变者中,SI梗死类型多见于MCA闭塞患者(x2=7.45,P＜0.05).LI梗死类型多见于MCA轻度或重度狭窄患者(x2=6.39,P＜0.05).结论 结合DWI和相应血管检查对于明确MCA区动脉粥样硬化性脑梗死的病因和机制有一定帮助.基底节区的腔隙梗死,相应血管检查正常提示小血管病的可能大;MCA存在一定狭窄则可能是穿支受累造成;ICA病变多累及皮层,包括皮层型分水岭区梗死;而不同程度的MCA病变其梗死形态没有本质区别,皮层下梗死更多见MCA闭塞患者.     

大面积脑梗死血管成像及血流动力学改变研究

目的 探讨大面积脑梗死颅内血管成像及血流动力学变化特点.方法 对39例大面积脑梗死患者在急性期进行颅脑MRI、MRA及TCD检查观察颅内血管成像及血流动力学变化情况.结果 39例大面积脑梗死患者中颈动脉闭塞7例,大脑中动脉闭塞17例,大脑中动脉狭窄及远端分支减少15例,大脑前动脉狭窄及闭塞5例,大脑后动脉狭窄3例,TCD显示大面积脑梗死病侧MCA Vm、ICA Vm明显低于对照组(P<0.05)和病灶对侧(P<0.05),双侧ACA Vm与对照组比较无显著差异:血管搏动指数和阻力指数(PI、RI)与对照组比较明显增大有显著差异(P<0.05).结论 大面积脑梗死患者MRA可直接了解颅内闭塞情况及狭窄程度,TCD可了解颅内血流动力学改变及血管阻力,从而了解梗死区血供情况,间接了解颅内压,为判断病情及预后提供参考.     

基于MRI和DSA的ICA、MCA狭窄或闭塞患者发生不同供血区脑梗死的对比分析

目的 探讨颈内动脉(ICA)、大脑中动脉(MCA)狭窄或闭塞引发脑梗死的部位及特点。方法 选取2013年1月～2016年2月本院诊治的98例经头颅磁共振加权成像(DWI)和数字减影血管造影(DSA)确诊的ICA或MCA狭窄或闭塞引发脑梗死患者进行回顾性研究,根据患者起病1周内的DWI确诊梗死部位,对比ICA和MCA狭窄或闭塞引发脑梗死的部位和特点。结果 ICA组患者的完全性前循环脑梗死率(36.00%)显著高于MCA组的12.50%(P<0.05); ICA组的腔隙性脑梗死发生率(26.00%)显著低于MCA组的52.08%(P<0.05); ICA组和MCA组患者的PI、PAI、LTI供血区脑梗死发生率无明显差异(P>0.05); MCA组患者的BZI供血区脑梗死发生率(62.50%)显著高于ICA组的26.00%(P<0.05); ICA组患者的单发性脑梗死发生率(70.00%)显著高于MCA组患者的(47.92%)(P<0.05)。结论 ICA狭窄以单发性脑梗死多见,MCA以多发性脑梗死多见,MCA狭窄或闭塞患者的分水岭梗死发生率高于ICA狭窄或闭塞患者。     

大脑中动脉严重狭窄或闭塞卒中类型分析

目的探讨大脑中动脉严重狭窄或闭塞患者卒中类型特点及其发病机制。方法经TCD确诊的大脑中动脉狭窄或闭塞患者,依据头部CT和(或)MRI所示梗死灶进行卒中分型。结果169例大脑中动脉严重狭窄或闭塞患者,卒中类型各亚型以腔隙性脑梗死(LI)最为常见,占38.46%,其次为分水岭梗死(WI)占19.23%。流域性脑梗死、弥散性多发点状脑梗死、半卵园中心梗死与MCA严重狭窄或闭塞程度有关。结论大脑中动脉严重狭窄或闭塞患者卒中类型以腔隙型脑梗死、分水岭梗死为主。卒中类型多种多样,血管检查应该作为缺血性脑血管病的常规检查。     

不同程度大脑中动脉狭窄与闭塞患者的梗死类型

目的通过对比研究不同程度大脑中动脉(middle cerebral artery,MCA)狭窄与闭塞所致脑梗死的临床特点及梗死类型,为大脑中动脉狭窄的防治提供依据。方法回顾性分析61例由大脑中动脉狭窄与闭塞所致的MCA供血区梗死患者的临床和影像学资料。将患者根据磁共振血管成像(magnetic resonance angiography,MRA)结果分为中度狭窄组32例、重度狭窄组12例和闭塞组17例。对患者的临床资料、磁共振弥散加权成像(diffusion-weighted magnetic resonance imaging,DWI)结果显示的脑梗死的部位进行对比。结果 MCA不同狭窄程度的3组患者的年龄、性别、有无高血压、糖尿病、冠心病、脑梗死、长期饮酒病史、血脂四项比较无统计学差异(P0.05),在有无长期吸烟史方面有统计学差异(P0.05)。Essen卒中风险评分与MCA狭窄程度无相关性(P0.05)。3组MCA病变程度的NIHSS神经功能缺损无统计学差异。不同MCA病变程度的患者梗死病灶数有统计学差异(P=0.004)。结论不同程度MCA狭窄与闭塞所致的脑梗死病灶数有统计学差异,而与NIHSS神经功能缺损无明显的相关性,因此关注MCA动脉粥样硬化斑块的性质、部位及发病机制对脑梗死的防治有重要意义。     

大脑中动脉粥样硬化性狭窄患者卒中类型分析

目的研究大脑中动脉粥样硬化性狭窄或闭塞(MCAOD)患者的卒中类型及其发病机制。方法经TCD和(或)MRA确诊的症状性MCAOD的患者,依据头部弥散加权核磁成像(DWI)所示梗死灶的特点进行分类,并与MCA狭窄程度进行相关性分析。结果84例症状性MCAOD患者中,73.8%的患者表现为多发性脑梗死,主要累及内交界区(53.6%)、半卵圆中心(29.1%)和皮层(22.6%)。皮层区域内梗死、交界区梗死、深部小梗死灶的发生率分别为46.4%、56.0%和44.0%,以多发小灶性梗死为主,很少引起MCA主干支完全梗死。且皮层支完全梗死、半卵圆中心梗死与严重MCA狭窄有关,而腔隙样梗死多见于轻度MCAOD患者。结论MCAOD患者可表现为各种梗死类型,以交界区梗死最常见,且多发性脑梗死为MCAOD患者最常见的表现类型,主要累及皮层下白质等部位,病灶以链型或弧线型分布为特点,动脉-动脉栓塞为其发病机制之一;深部小梗死多为孤立病灶,与MCA主干粥样硬化斑继发的血栓堵塞豆纹动脉入口有关。     

分水岭脑梗死的临床研究及磁共振特征分析

目的探讨分水岭脑梗死(CWSI)的临床特征、治疗、头部磁共振成像(MRI)及磁共振血管成像(MRA)特征和临床应用价值。方法对我院48例分水岭脑梗死患者回顾分析。结果治愈26例,显著进步12例,好转8例;恶化、死亡各1例;MRI显示皮质前型8例,皮质后型14例,皮质下型24例,混合性2例;MRA显示颈内动脉狭窄或闭塞17处,大脑前动脉或闭塞10处,中动脉狭窄或闭塞8处,大脑后动脉6处,椎基底动脉6处。结论全身血压下降、颈内动脉等脑主干动脉狭窄或闭塞引起分水岭区域血液动力学障碍、血流改变以及微栓塞、Willis环完整性是主要发病原因,磁共振成像对分水岭脑梗死能提供更多的影像学信息。     

The arterial patterns associated with internal carotid disease and cerebral infarcts

In 20 necropsies with 15 stenosed and 17 thrombotic occluded internal carotid arteries there were 46 cerebral infarcts larger than 1 cm diameter. Using portmortem arteriographic and pathological techniques the patterns of the neck and brain artery systems were correlated with the situation and extent of the brain infarcts. Massive infarcts involving two major cerebral artery territories were associated with distal internal carotid artery occlusion and grossly ineffective cervical and circle of Willis anastomoses. Isolated middle cerebral artery territory infarcts were associated with internal carotid occlusion or stenosis and impairment of the circle of Willis anastomoses, perhaps with middle cerebral artery stenosis. The pattern of adequate size arteries determined if these infarcts were total, deep central, anterior, medium or posterior partial territory infarcts. Boundary zone infarcts were associated with internal carotid artery disease and limitation of anterior or posterior circle of Willis anastomoses. These limitations determined which boundary zones were affected. Isolated anterior cerebral artery territory infarcts were associated with bilateral internal carotid disease and an anterior cerebral artery stenosis or small caliber anterior communicating artery. Isolated posterior cerebral artery territory infarcts were associated with internal carotid disease and a direct impairment of the ipsilateral posterior cerebral artery capability.     

Unilateral watershed cerebral infarcts

We studied 51 patients with symptomatic unilateral watershed (WS) cerebral infarct on CT. In 22 patients, the infarct was between the superficial territory of the anterior and middle cerebral arteries, 20 had an infarct between the superficial territory of the middle and posterior cerebral arteries, and 9 had an infarct between the superficial and deep territory of the middle cerebral arteries. Each type had a characteristic neurologic picture. Syncope at onset (37%) and focal limb shaking (12%) were frequent. Thirty-eight patients (75%) had internal carotid artery occlusion or tight stenosis associated with a hemodynamically significant cardiopathy, increased hematocrit, or acute hypotension. Embolic infarction was probable in only two patients (4%) who had only atrial fibrillation.     

Double infarction in one cerebral hemisphere

Thirty-two patients whose first stroke was due to double infarct in one cerebral hemisphere were identified among 1,911 consecutive patients from the Lausanne Stroke Registry. The double infarct involved territories of the superficial middle cerebral artery, superficial posterior cerebral artery, lenticulostriate, anterior choroidal artery, or borderzone. The most common combination involved territories of the anterior middle cerebral artery plus the posterior middle cerebral artery. In the patients with the double infarct, the prevalence of potential cardiac sources of embolism (19%) was similar to that found in the registry in general, but the double infarct was closely associated with tight (greater than or equal to 90% of the lumen diameter) stenosis or occlusion (75%) of the internal carotid artery. The most common neurological picture mimicked large infarction in the middle cerebral artery territory, but nearly half of the patients with double infarct in one cerebral hemisphere had a specific clinical syndrome, which was not found in the 1,879 remaining patients from the registry, including hemianopia-hemiplegia (in 6), acute conduction aphasia-hemiparesis (in 2), and acute transcortical mixed aphasia (in 6), in relation to characteristic combinations of infarcts. These unique clinical and etiological correlates warrant the recognition of double infarct in one cerebral hemisphere from other acute ischemic strokes.     

Weakness of the lower extremity in carotid occlusive disease

Nineteen patients experienced progressive or episodic weakness of one lower extremity caused by severe stenosis or occlusion of the internal carotid artery. The majority of patients (84.2%) had occlusion or severe stenosis at the origin. Based on clinical profiles, angiographic findings, and cerebral blood flow patterns, we concluded that the pathophysiologic mechanism was hypoperfusion in the border zone between the anterior cerebral artery and the middle cerebral artery and that patients with progressive weakness had more extensive compromise in cerebral circulation. Following surgical treatment in 17 patients, progressive and episodic weakness disappeared and the majority of them (76.4%) became asymptomatic. However, the patients with stenosis at the siphon and those with progressive weakness from occlusion at the origin appeared to be at increased risk for cardiac death.     

Occipital infarction with hemianopsia from carotid occlusive disease

Extracranial internal carotid artery occlusive disease usually produces stroke in the middle cerebral artery territory or the border zone between the middle and anterior cerebral arteries. It is unusual for occipital infarction in the posterior cerebral artery territory to be caused by internal carotid artery disease despite the fact that the posterior cerebral artery may arise directly from the internal carotid artery as an anatomic variation. We describe a patient with a fetal posterior cerebral artery originating from the internal carotid artery, and the initial manifestation of his extracranial internal carotid artery occlusive disease was hemianopsia from occipital infarction.     

伴颅内外动脉狭窄或闭塞的分水岭脑梗死类型分析

目的探讨由颈内动脉(ICA)或大脑中动脉(MCA)狭窄或闭塞引起的分水岭脑梗死(WSI)的梗死类型及发病机制。方法 81例急性WSI患者根据责任血管分为ICA组(53例)及MCA组(28例)。根据MRI检查结果对两组梗死类型进行分析比较。结果 ICA组皮质前型及皮质前型+内WSI+皮质后型的比率显著高于MCA组(均P<0.05)。结论合并颅内外血管狭窄或闭塞WSI类型以内WSI及皮质后型梗死最常见。ICA病变患者WSI皮质前型常见,其发病机制可能为血流动力学障碍;MCA病变患者WSI皮质上型及合并融合性病灶多见,其机制可能为微栓子对远端血管的微栓塞。     

儿童烟雾病脑梗死影响因素分析

目的 分析儿童烟雾病（Moyamoya disease,MMD）的临床及影像学特征。 方法 回顾性分析176例儿童缺血型烟雾病患者临床资料,分为脑梗死组和非梗死组。组间的特征 和影像学参数采用单因素分析和多因素分析,评估脑梗死的危险因素。 结果 儿童缺血型烟雾病中脑梗死好发于女童（P =0.006）。大脑前动脉（anterior cerebral artery, ACA）、大脑中动脉（middle cerebral artery,MCA）和颈内动脉（internal Carotid Artery,ICA）狭窄程度 是脑梗死发生的危险因素（P＜0.001,0.014和＜0.001）。多因素分析显示颈内动脉狭窄[比值比（odds ratio,OR）6.945,95%置信区间（confidence interval,CI）1.406～34.302,P =0.017）、脉络膜后动脉 代偿（OR 0.780,95%CI 0.078～0.324,P =0.000）、后交通动脉代偿（OR 3.288,95%CI 1.521～7.111, P =0.002）与脑梗死发生独立相关。 结论 儿童缺血型烟雾病中,脑血管狭窄程度以及侧支循环代偿情况与脑梗死发生有关。     

Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: a diffusion-weighted imaging and microemboli monitoring study

Although most therapeutic efforts and experimental stroke models focus on the concept of complete occlusion of the middle cerebral artery as a result of embolism from the carotid artery or cardiac chamber, relatively little is known about the stroke mechanism of intrinsic middle cerebral artery stenosis. Differences in stroke pathophysiology may require different strategies for prevention and treatment. We prospectively studied 30 consecutive acute ischemic stroke patients with middle cerebral artery stenosis detected by transcranial Doppler and magnetic resonance angiography. Patients underwent microembolic signal monitoring by transcranial Doppler and diffusion-weighted magnetic resonance imaging. Characteristics of acute infarct on diffusion-weighted magnetic resonance imaging were categorized according to the number (single or multiple infarcts) and the pattern of cerebral infarcts (cortical, border zone, or perforating artery territory infarcts). The data of microembolic signals and diffusion-weighted magnetic resonance imaging were assessed blindly and independently by separate observers. Diffusion-weighted magnetic resonance imaging showed that 15 patients (50%) had single acute cerebral infarcts and 15 patients had multiple acute cerebral infarcts. Among patients with multiple acute infarcts, unilateral, deep, chainlike border zone infarcts were the most common pattern (11 patients, 73%), and for single infarcts, penetrating artery infarcts were the most common (10 patients, 67%). Microembolic signals were detected in 10 patients (33%). The median number of microembolic signals per 30 minutes was 15 (range, 3-102). Microembolic signals were found in 9 patients with multiple infarcts and in 1 patient with a single infarct (p = 0.002, chi(2)). The number of microembolic signals predicted the number of acute infarcts on diffusion-weighted magnetic resonance imaging (linear regression, adjusted R(2) =0.475, p < 0.001). Common stroke mechanisms in patients with middle cerebral artery stenosis are the occlusion of a single penetrating artery to produce a small subcortical lacuna-like infarct and an artery-to-artery embolism with impaired clearance of emboli that produces multiple small cerebral infarcts, especially along the border zone region.     

DSA对老年性颈内动脉重度狭窄或闭塞患者侧支循环的应用价值

目的 探讨DSA对老年性颈内动脉重度狭窄或闭塞患者侧支循环的诊断价值.方法 广西右江民族医学院附属医院神经内科自2008年8月至2010年7月收治一侧颈内动脉重度狭窄或闭塞的缺血性脑血管病患者23例,回顾性分析患者的DSA表现与预后.结果 DSA显示有充分侧支循环代偿18例(78.3%),其中前交通动脉代偿16例,后交通动脉代偿6例,前交通动脉和后交通动脉代偿3例,脉络膜前动脉代偿5例,大脑前动脉和大脑中动脉之间的软脑膜动脉代偿5例,大脑后动脉和大脑中动脉之间的软脑膜动脉代偿4例,眼动脉代偿15例,大脑后动脉与小脑上动脉之间吻合3例,小脑上动脉、小脑前下动脉和小脑后下动脉之间吻合2例;随访1～22个月,患者临床症状全部消失并未再复发.无侧支循环代偿5例,其中2例瘫痪患者肌力由0级恢复到Ⅲ级,生活无法自理;2例意识障碍没有恢复,因肺部感染而死亡;1例患者失语无法恢复.结论 DSA可以准确判断老年性颈内动脉重度狭窄或闭塞患者侧支循环的存在方式和代偿能力,为治疗方法的选择和预后的判断提供可靠依据.

Abstract：

Objective To investigate the diagnostic value of aortocranial DSA in collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotid artery. Methods Twenty-three elderly patients with serious stenosis or occlusion of the internal carotid artery, admitted to our hospital from August 2008 to July 2010, were chosen; their DSA findings and prognoses were retrospectively analyzed. Results Of these 23 patients, the collateral circulation was seen in 18(78.3%), including compensations from anterior communicating artery (n=16), posterior communicating artery (n=6), anterior together with posterior communicating artery (n=3), anterior choroidal artery (n=5),meningina artery between anterior cerebral artery and posterior cerebral artery (n=5), meningina artery between posterior cerebral artery and middle cerebral artery (n=4), ophthalmic artery (n=15), blood vessel between posterior cerebral artery and superior cerebellar artery (n=3), and blood vessel among superior cerebellar artery, anterior inferior cerebellar artery and posterior inferior cerebellar artery (n=2); after conservative treatment and long time follow-up (1 to 22 months with a mean of 11.2 moths),disappearance of clinical symptoms and no recurrence were found in these 18 patients. Five patients were noted without compensatory collateral circulation: the 2 paralysis patients could not take care of themselves even with the improvement of myodynamia from grade 0 to grade Ⅲ; the 2 patients with disturbance of consciousness showed no recovery and died from lung infection; the left 1 patient was having aphasia. Conclusion DSA can accurately define ways and compensative ability of collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotidartery, which can put forward reliable evidences for their treatments and prognoses.