120例颅内外脑供血动脉严重狭窄或闭塞患者全脑血管造影分析

目的 探讨颅内外脑供血动脉狭窄或闭塞患者的全脑血管造影特点.方法 对经全脑血管造影证实的120例颅内外脑供血动脉严重狭窄或闭塞病例的血管造影资料进行分析.根据年龄将患者分为青年组(6～44岁,48例)、中年组(45～59岁,41例)和老年组(≥60岁,31例).结果 全组病例共有狭窄或闭塞324处,单纯颅内动脉狭窄占47%,显著高于单纯颅外动脉狭窄占35%和颅内外狭窄并存占18%.青年组单纯颅内动脉狭窄比例为79%,显著高于中年组(29%,P<0.01)和老年组(19%,P<0.01);青年组单纯颅外血管狭窄比例为10%,显著低于中年组(46%,P<0.01)和老年组(58%,P<0.01);青年组前循环狭窄比例为97%,显著高于中年组(75%,P<0.01)和老年组(56%,P<0.01).脑梗死患者单纯颅内动脉狭窄占35%,单纯颅外动脉狭窄占42%,颅内外动脉狭窄并存占23%;短暂性脑缺血发作(transient ischemic attack,TIA)患者单纯颅内动脉狭窄占44%,单纯颅外动脉狭窄占39%,颅内外动脉狭窄并存占17%.82%的脑(室)出血发生于单纯颅内动脉狭窄患者.共107例患者存在梗死灶,其中99例梗死灶与动脉狭窄部位存在相关性.部分患者存在高血压、吸烟、高脂血症、高龄和糖尿病等危险因素,与狭窄分布模式有一定关系.结论 脑供血动脉狭窄的最多发部位是颈内动脉.单纯颅内动脉狭窄以青年人多见,随年龄的增长颅外动脉狭窄比例逐渐增高,颅内外动脉狭窄并存情况逐渐增多,前循环狭窄比例逐渐降低,而后循环狭窄比例逐渐升高.脑梗死、TIA和脑(室)出血患者动脉狭窄好发部位各不相同.缺血性脑血管病患者梗死灶与动脉狭窄部位密切相关.高血压对患者形成颅内外动脉狭窄影响最大,高龄和糖尿病对颅外动脉狭窄影响较大.

Analysis of cerebral angiogtaphy in 120 patients with craniocervical artery severe stenosis or occlusion

Objeclive To investigate the characteristics of cerebral angiography in patients with craniocervical artery severe stenosis or occlusion. Methods The data of cerebral angiography confirmed in 120 patients with craniocervical artery severe stenosis or occlusion were analyzed. They were divided into young (aged 6-44 years, n = 48), middle-aged (aged 45-59 years, n=41) and elderly (aged ≥60 years, n =31) groups according to their ages. Results There were 324 stenosises or occlusions in all the patients, the intracranial artery stenosis was 47%, extracranial artery stenosis was 35%, and the coexistence of craniocervical artery stenosis was 18%. The proportion of intracranial artery stenosis in the young group (79%) was significantly higher than that in the middle-aged group (29%, P <0.01) and that in the elderly group (19%, P <0.01); the proportion of extracranial artery stenosis in the young group (10%) was significantly lower than that in the middle-aged group (46%, P <0. 01) and that in the elderly group (58%, P <0. 01); the proportion of artery stenosis in anterior circula-tion in the young group (97%) was significantly higher than that in the middle-aged group (75%, P <0.01) and that in the elderly group (56%, P <0. 01). The proportion of intracranial artery stenosis was 35% in patients with cerebral infarction, while extracranial artery stenosis was 42%, and the coexistence of craniocervical artery stenosis was 23% ; the proportion of intracranial artery stenosis in patients with transient ischemic attack (TIA) was 44%, while extracranial artery stenosis was 39%, and the coexistence of craniocervicai artery stenosis was 17%. 82% intracerebral hemorrhage and intraventricular hemorrhage occurred in patients with intracranial artery stenosis. A total of 107 patients had cerebral infarct lesions, among them; the infarct lesions of 99 patients were correlated with the stenosis locations, There were some risk factors, such as hypertension, smoking, hyperlipoidemia, advanced age, and diabetes in part of the patients. They had certain relations with the distribution mode of stenosis. Conclusions The most predilection site of cerebral artery stenosis is internal carotid artery. The intracranial artery stenosis is more common in young adults. With the age increasing, the proportion of extracranial artery stenosis is increasing gradually, so is the coexistence of craniocervicai artery stenosis. The proportion of artery stenosis in anterior circulation decreases gradually and in posterior circulation increases gradually. The predilection sites are different in artery stenosis in patients with cerebral infarction, TIA, intracerebral hemorrhage and intraventricular hemorrhage. The cerebral infarct lesions in patients with ischemic cerebrovascular disease are closely correlated with their artery stenosis locations. Hypertension has the most impact on the formation of craniocervical artery stenosis in patients, and advanced age and diabetes have greater impact on extracranial artery stenosis.