Willis环侧支影响急性缺血性脑血管病的代偿及灌注

目的 利用计算机断层扫描血管成像（computed tomography angiography，CTA）及计算机断层扫描灌注成像（computed tomography perfusion，CTP）技术研究Willis环侧支建立情况在急性缺血性脑血管病中的代偿及灌注差异。方法 本研究为回顾性研究，连续纳入首都医科大学附属北京友谊医院神经内科2011年12月～2013年2月期间住院的急性缺血性脑血管病患者231例，根据颅脑磁共振弥散加权成像（diffusion weightedimaging，DWI）有无高信号将患者分为脑梗死（cerebral infarction，CI）组和短暂性脑缺血发作（transientischemic attack，TIA）组，并进一步根据缺血症状或梗死部位分为前、后循环TIA组及前、后循环CI组。其中前循环TIA组59例，后循环TIA组66例，前循环CI组57例，后循环CI组49例，收集所有患者的CTA和CTP资料，记录患者的Willis环代偿情况，并将其分为Ⅰ型（对称型）、Ⅱ型（前部不完整）、Ⅲ型（后部不完整）、Ⅳ型（混合不完整）。分析Willis环不同分型及完整性与上述4组之间的关系。结果 所有患者按Willis环形态分4型（Ⅰ型占7.8%、Ⅱ型占4.3%、Ⅲ型占38.5%、Ⅳ型占49.4%）。TIA组与CI组相比，Ⅰ型、Ⅲ型Willis环多（4组中Ⅰ型和Ⅲ型所占比例分别为11.86%，7.58%，2.83%，2.83%及49.15%，46.96%，16.03%，11.32%）。前交通动脉显示率在TIA组中更高（χ2=10.832，P =0.001），灌注异常者中以Ⅳ型所占比例最高（60.33%），Ⅰ、Ⅱ、Ⅲ型所占比例低于灌注正常组（χ2=12.356，P =0.006）。结论 不同Willis环结构的比例存在差异，其中以Ⅲ型、Ⅳ型最为多见。在发生急性缺血性脑血管病时，前交通的开放可能起到一定的代偿作用，Willis环不完整的患者出现灌注异常的情况更多见。

Collateral Circulation of the Circle of Willis Affects the Compensation and Perfusion of Acute Ischemic Cerebrovascular Disease

Objective To investigate the compensatory and perfusion differences in acute ischemic cerebrovascular disease （ICVD） with collateral establishment of circle of Willis by computed tomography angiography （CTA） and computed tomography perfusion （CTP）. Methods This retrospective study enrolled 231 patients with acute ICVD, who were treated in Beijing Friendship Hospital of Capital Medical University from December 2011 to February 2013. They were divided into cerebral infarction （CI） group and transient ischemic attack （TIA） group according to diffusion weighted imaging of magnetic resonance imaging. Based on their symptoms and imaging, the patients were divided into anterior circulation TIA （59 cases）, posterior circulation TIA （66 cases）, anterior CI （57 cases） and posterior CI （49 cases）. Collect the data of CTA and CTP to describe the circle of Willis, and divide them into four types： （1） Type I, showing an intact circle;（2） Type II, anterior part incompletely; （3） Type III, posterior part incompletely; （4） Type IV, both anterior and posterior parts incompletely. And analyze the relation between the circle of Willis and cerebral ischemic disease in those 4 groups. Results In all 231 cases, circle of Willis Type I, II, III and IV was found in 7.8%, 4.3%, 38.5%and 49.4%, respectively. The frequency of Type I and III in TIA group were more than these in CIgroup. The frequency of the anterior communicating artery （ACoA） segment in TIA group were more than CI group （χ2=10.832,P=0.001）. The patients with abnormal perfusion area had most rate of Willis circle Type IV （60.33%）, the rates of Type Ⅰ、Ⅱ、Ⅲwere less than normal perfusion group （χ2=12.356,P=0.006）. Conclusion Our study suggests that the potential of the primary collateral circulation is ultimately determined by the anatomic variability of Willis circle. ACoA may play a compensatory role when ICVD occurred. Perfusion abnormality in patients with ICVD was associated with the incomple