单侧和双侧颈内动脉狭窄或闭塞侧支循环途径的研究

目的研究单侧和双侧颈内动脉狭窄或闭塞的侧支循环方式。方法经DSA、MRA确诊的颈内动脉狭窄或闭塞者95例,分为单侧和双侧病变组。分析DSA、MRA结果,对比两组病例侧支循环方式。结果DSA和MRA上,单侧病变组前交通动脉出现率明显高于双侧病变组(P<0.05),后交通动脉出现率在两组间无统计学差异(P>0.05)。DSA上,眼动脉出现率在两组间无统计学差异;双侧病变组眼动脉增粗率(57.9%)高于单侧组(32%)。双侧病变组软脑膜吻合支出现率明显高于单侧组(P<0.01)。结论单侧和双侧颈内动脉狭窄或闭塞的侧支方式不同,单侧病变主要通过前交通动脉、同侧后交通动脉等代偿,双侧病变主要侧支是后交通动脉、眼动脉和软脑膜吻合支。

Unilateral and bilateral internal carotid artery stenosis or occlusion: a study of the secondary collateral circulation

Objective It's a study of the collateral circulation secondary to unilateral and bilateral internal carotid artery(ICA)severe stenosis or occlusion using digital subtract angiography(DSA)and magnetic resonance angiography(MRA).Methods Ninty-five patients with ICA stenosis or occlusion were diagnosed by DSA or MRA.Forty-four patients were assessed by DSA,and fifty-one patients were evaluated by MRA,who were divided into two groups of the unilateral and bilateral involvement.DSA,MRA findings were analyzed,by which the patterns of the collateral circulation were comparatively studied.Results The presence rate of anterior communicating artery(AcoA)in the unilateral group on DSA and MRA was significantly higher than that in the bilateral group(P< 0.05);while there was no significant difference in the presence rate of posterior communicating artery(PCoA)between the two groups(P >0.05).On DSA,the presence rate of ophthalmic artery(OphA)in the unilateral and bilateral groups had no significant difference between the two groups.The augmentation rate of the OphA in the bilateral group was significantly higher than that in the unilateral group(P< 0.05).The presence rate of leptomeningeal anastomosis in the bilateral group was significantly higher than that in the unilateral group on DSA and MRA(P< 0.01).Conclusion In patients with the unilateral and bilateral ICA stenosis or occlusion,the collateral circulation formats in different patterns.The major collateral pathways secondary to the unilateral ICA stenosis or occlusion are AcoA and ispilateral PCoA,while to the bilateral ICA stenosis or occlusion are PCoA,OPhA,and leptomeningeal anastomosis.