颈内动脉急性闭塞致大面积脑梗死侧支循环建立及影响因素

目的评估颈内动脉急性闭塞致大面积脑梗死侧枝循环建立情况及影响因素。方法纳入29例经诊断为颈内动脉急性闭塞致大面积脑梗死的患者,所有患者均行颈动脉超声、经颅多普勒超声(TCD)、头颅CT、头颅磁共振血管造影(MRA)、心电图检查,同时收集患者基本信息。结果一级侧枝循环建立与糖尿病显著相关(P 0. 05),与房颤、高血压、吸烟、NIHSS评分无关(P 0. 05)。二级侧枝循环建立与房颤、高血压、糖尿病、吸烟、NIHSS评分均无关(P 0. 05)。心源性脑栓塞导致的急性大面积脑梗死与脑疝显著相关(P 0. 05)。TCD评估一级侧枝循环的建立与MRA具有高度一致性(Kappa值=0. 656,P 0. 05)。结论糖尿病可促进颈内动脉急性闭塞导致的大面积脑梗死一级侧枝开放。心源性脑栓塞导致的大面积脑梗死易发生脑疝。TCD可以较好评估颈内动脉急性闭塞导致的大面积脑梗死的一级侧枝循环建立。

Establishment of collateral circulation in massive cerebral infarction caused by acute internal carotid artery occlusion and related influencing factors

Objective To investigate the establishment of collateral circulation in patients with massive cerebral infarction caused byacute internal carotid artery (ICA) occlusion and related influencing factors.Methods A total of 29 patients who were diagnosed with massive cerebral infarction caused byacute ICA occlusion were enrolled, and all of them underwent carotid artery ultrasound, transcranial Doppler (TCD), head CT scan, cranial magnetic resonance angiography (MRA), and electrocardiography (ECG). Related information was also collected.Results Establishment of primary collateral circulation was significantly associated with diabetes (P<0.05), but was not associated with atrial fibrillation, hypertension, smoking, and NIHSS score (P>0.05). Establishment of secondary collateral circulation was not associated with atrial fibrillation, hypertension, diabetes, smoking, and NIHSS score (P>0.05). Acute massive cerebral infarction caused by cardiogenic cerebral embolism was significantly associated with cerebral hernia (P<0.05). Establishment of primary collateral circulation assessed by TCD was highly consistent with that assessed by MRA (Kappa=0.656, P<0.05).Conclusions Diabetes can promote primary collateral opening in patients with massive cerebral infarction caused by acute ICA occlusion. Patients with massive cerebral infarction caused by cardiogenic embolism are likely to develop cerebral hernia. TCD is an effective tool forassessing the establishment of primary collateral circulation in patients with massive cerebral infarction caused by acute ICAocclusion.