单侧颈动脉闭塞脑梗死和侧支代偿情况分析

目的 通过计算机断层扫描（computer tomography，CT）和磁共振成像（magnetic resonance imaging，MRI）研究闭塞颈动脉同侧半球的梗死情况，分析不同侧支的代偿能力，增进我们对梗死机制的理解。方法 颈部血管彩色超声证实的43例单侧颈动脉闭塞患者，将颈动脉闭塞同侧的大脑半球分为大脑中动脉皮层区域、前皮层分水岭区域、后皮层分水岭区域、内分水岭区域、穿支动脉供血区域，比较各个解剖区域发生梗死情况，并分析侧支代偿种类和不同解剖部位梗死的关系。结果 颈动脉闭塞时，内分水岭区发生梗死最多见19例（44.2%），8例前皮层分水岭梗死有6例伴有内分水岭区梗死。后交通动脉（posterior communicating artery，PCoA）出现是减少内分水岭区梗死的保护性因素比值比（odd ratio，OR）为0.226，95%可信区间（confidence interval，CI）在0.058～0.833间，P =0.027]。结论 颈动脉闭塞时，内分水岭区发生梗死最多见，提示内分水岭区是对血流下降最敏感的区域。PCoA开放能够减少内分水岭区梗死。

Analysis of Cerebral Infarction and Collateral Flow in Patients with Unilateral Carotid Artery Occlusion

Objective To investigate the cerebral infarction by computer tomography （CT） and magnetic resonance imaging （MRI） ipsilateral to carotid artery occlusion in patients with unilateral carotid artery occlusion and the association between ischemic brain lesions and intracranial collateral blood flow. To promote our understanding of the pathophysiology of cerebral ischemia. Methods Forty-three patients with unilateral carotid artery occlusion confirmed by coratid ultrasound were included. The numbers of infarction were compared in each of five cerebral anatomic regions ipsilateral to the occlusion. The five regions were territory cortical region of middle cerebral artery （MC）, anterior watershed cortical region （AWS）, posterior watershed cortical region （PWS）, internal watershed region （IWS）, and perforating artery region （PA）. The associations between collateral blood flow pattern and infarction in five regions were analyzed. Results The frequency of IWS infarcts in the hemisphere ipsilateral to the occluded carotid artery was higher （n=17, 44.2%）. Six of eight AWS infarcts coexisted with IWS infarcts. The presence of Posterior communicating artery （PCoA） was a protective factor associated with a reduction in prevalence of IWS infarcts （odd ratio （OR） =0.226, 95% confidence interval （CI）： 0.058-0.833, P=0.027）. Conclusion Higher frequency of IWS infarcts and most of AWS infarcts coexisted with IWS infarcts suggested a hemodynamic mechanism for stroke with occlusive coratid disease. PCoA was a protective factor associated with a reduction in prevalence of IWS infarcts.