TCD和DSA评价脑血管病变侧支代偿的临床价值

目的探讨数字减影血管造影(DSA)、经颅多普勒超声(TCD)评价脑血管病变侧支代偿的意义。方法对91例脑血管病变患者用TCD和DSA检测判断侧支代偿。结果(1)38例为一侧颈内动脉狭窄或闭塞,53例为一侧椎动脉闭塞。(2)颈内动脉狭窄或闭塞:经眼动脉的颅内外侧支代偿在TCD上的显示率(50.0%)高于DSA上的显示率(13.2%)(P<0.05);软脑膜血管吻合代偿在DSA上的显示率(42.1%)高于在TCD上的显示率(13.2%)(P<0.05)。(3)椎动脉闭塞:TCD检测对侧椎动脉的代偿(75.5%)占有明显的优势;DSA检测后交通动脉开放(17.0%)占有明显的优势。对侧椎动脉代偿的几率(40/53,75.5%)高于其他代偿途径,包括枕动脉和椎动脉之间吻合代偿(5/53,9.4%)、颈深动脉和椎动脉之间的侧支吻合代偿(6/53,11.3%)以及椎动脉闭塞时后交通动脉开放(9/53,17.0%)(P<0.05);一侧椎动脉闭塞时有椎动脉代偿者合并对侧椎动脉粥样硬化病变的几率高于无代偿者(P<0.05)。结论DSA对脑血管病变侧支代偿评价有重要意义,为术前必须检查;TCD有助于了解脑血管病变侧支代偿能力,可作为首选方法。

The clinical value of TCD and DSA on assessment collateral compensative in cerebral vascular diseases

Objective To evaluate the diagnosis value of TCD and DSA on collateral compensative in cerebral vascular diseases. Methods TCD and DSA were applied in 91 cases of cerebral vascular diseases to test and measure the collateral compensative capacity. Resnlts （ 1 ） There were 38 cases of stenos or occlusion of unilateral internal carotid artery and 53 cases of the occlusion of unilateral vertebral artery. （ 2 ） Stenos or occlusion of internal carotid artery：the presence rate of ophthalmic artery on TCD（50.0% ） was higher than that of DSA（ 13.2% ） （ P 〈 0.05 ）. The presence rate of leptomeningeal anastomose on DSA （42.1%） was higher than that of TCD （13.2%） （ P 〈 0.05 ）. （ 3 ） Occlusion of vertebral artery： the presence rate of the compensation of contralateral vertebral arteries on TCD （75.5%）was clearly higher than that of DSA,the presence rate of the posterior communication artery on DSA （ 17.0% ） was clearly higher than that of TCD （ P 〈0. 05 ）. The presence rate of the compensation of contralateral vertebral arteries（40/53 = 75.5% ） was higher than that of other compensative pathway including the collateral compensative between occipital arteries and vertebral arteries （ 5/53 = 9.4% ）, and between cervicalis profunda arteries （6/53 = 11.3% ） and opening of posterior communication artery （9/53 = 17.0% ） （ P 〈 0.05 ）. The rates of the combination of contralateral vertebral atherosclerosis in the case of unilateral occlusion with compensative are higher than those without compensative （ P 〈 0.05 ）. Conclusion DSA is highly valuable for the evaluation of collateral compensative in cerebral vascular diseases, and it is necessary in preoperative examination. TCD is helpful in measu ring collateral compensative capacity of cerebral vascular diseases, and useful for the disease diagnosis.