超声对单侧颈内动脉严重狭窄或闭塞时颅内动脉血流动力学变化的研究

目的:分析并评价单侧颅外段颈内动脉(ICA)严重狭窄(≥70%)或闭塞时颅内侧支循环建立的情况。方法:彩色多普勒显像(CDFI)筛选出单侧颅外段ICA严重狭窄或闭塞患者42例,应用经颅彩色多普勒(TCCD)评价颅内主要动脉的血流动力学变化,并经数字减影血管造影术(DSA)检查结果证实。结果:1.与DSA比较:TCCD探测前交通动脉(AcoA)和眼动脉(OA)具有较高的敏感性、特异性,对AcoA探测的价值最大,其次是后交通动脉(PcoA)。2.AcoA的开放与卒中的发生呈负相关。3.患侧大脑中动脉(MCA)的收缩期峰值流速(PSV)及搏动指数(PI)值均较健侧明显减低(P<0.05)。卒中组和短暂性脑缺血发作(TIA)组患侧OA的PI值明显低于健侧(P<0.05)。结论:CDFI和TCCD检测可综合分析颅内主要动脉的血流动力学变化,准确、可靠及无创地评价颅内侧支循环的情况,对单侧ICA严重狭窄或闭塞患者的治疗和预后的判断具有重要的临床价值。

Ultrasonography in evaluate of hemodynamics changes of intrarerebral collaterals circulation with unilateral severe stenosis or occlusion internal carotid artery

Objective： To study and evaluate the unilateral severe stenosis（ ≥ 70% ） or occlusion of the extracranial internal carotid artery （ICA） on hemodynamics changes of intracranial collateral circulation. Method： Color Doppler flow imaging（CDFI） was used to examine the patients of Forty-two cases with unilateral severe stenosis （≥ 70% ） or occlusion of the extracranial ICA. Transcranial color Doppler ultrasonography（TCCD） was applied to evaluate the hemodynamics change of the basall intracranial arteries, and confirmed by digital subtraction angiography （DSA） were examined. Result： 1. Compared with DSA, TCCD had a higher sensitivity（SEN） and specificity（SPE） for detection anterior communicating artery（AcoA） ang ophthalmic artery（ OA）, and it was more accuracy for detection of AcoA than that of posterior communicating artery（ PcoA）. 2. The opening of AcoA was in negative relation with the occurrence of stroke. 3. The peak systolic velocity（PSV） on the unilateral severe stenosis or occlusion sides middle cerebral arteries（MCA） was lower than contralateral side, and the same with PI. Conclusion： CDFI and TCCD can offer us a noninvasive quantification on the basal intracerebral arteries of hemodynamic changes, TCCD can be determined the intracerebral arterial collateral condition trustiness and was significant to evaluate severe stenosis or occlusion of the extraeranial ICA.