缺血性卒中病变血管和侧支循环代偿的研究

目的 观察缺血性卒中患者的责任病变血管及其侧支循环代偿方式,探讨脑动脉闭塞或严重狭窄时侧支循环的代偿作用与牛津郡社区卒中项目(OCSP)临床症状分型之间的关系.方法对211例缺血性卒中患者采用OCSP分型(完全型前循环梗死36例,部分前循环梗死94例,后循环梗死31例,腔隙性梗死50例),进行数字减影全脑血管造影检查,判定梗死的责任血管、侧支循环是否建立及代偿方式.结果 检出有病变血管的患者198例,共累及病变血管206支,责任血管为颈内动脉98条、大脑中动脉54条、椎动脉27条、颈总动脉6条、基底动脉5条、锁骨下动脉4条、大脑前动脉及大脑后动脉各2条;经Willis环代偿98例,软脑膜支吻合115例,颅外代偿46例.结论脑动脉病变最多位于颈内动脉、大脑中动脉,其次位于椎动脉,前循环病变较后循环病变具有更高的梗死发生率;侧支循环代偿以Willis环最充分,软脑膜支吻合最常见;脑梗死的临床分型受病变血管与侧支循环代偿的综合影响.

Compensation of diseased vessels and their collateral circulation in patients with ischemic stroke

Objective To observe the compensations of diseased arteries and their collateral circulation in patients with ischemic stroke and explore the relation between compensation of collateral circulation and classification of clinical symptoms (Oxfordshire Community Stroke Project OCSP] classification) in total or severe infarction cases. Methods Based on OCSP classification, we performed digital subtraction angiography (DSA) on 211 patients with cerebral infarction to identify the existence of diseased arteries and their collateral circulations, and the appearance of their compensations. Results one hundred and ninety-eight patients were identified as having diseased arteries with a total number of 206, including 98 internal carotid arteries (ICAs), 54 middle cerebral arteries (MCAs), 27 vertebral arteries (VAs), 6 common carotid arteries (CCAs), 5 basilar arteries (BAs), 4 subclavian arteries (SCAs) and 4 other arteries. Leptomeningeal anastomose compensated 115 arteries, Willis circle compensated 98, and the other 46 were compensated by external-cranium arteries. Conclusions ICAs and MCAs are the firstly involved arteries in patients with cerebral infarction, followed by VAs. Anterior circulation arteries lesions arouse more cerebral infarctions than posterior circulation arteries lesions do. Compensation by Willis circle is the most sufficient type in ischemic stroke cases;while compensation by Leptomeningeal anastomose is the most frequent one. The classification of cerebral infarction is mainly affected by the compensations of diseased arteries and collateral circulation.