短暂性脑缺血发作临床表现与病变血管及侧支循环的关系

目的探讨短暂性脑缺血发作(TIA)的临床表现与病变血管及侧支循环的关系。方法纳入158例在发病的1～7d内行全脑DSA检查的TIA患者。根据临床表现将其分为前循环TIA组和后循环TIA组。分析两组患者的脑动脉狭窄、侧支循环建立情况及临床表现与责任病变血管的符合情况。结果①158例TIA患者中,临床表现为前循环TIA 32例(20.3%),后循环TIA126例(79.7%)。122例(77.2%)存在颅内外动脉狭窄或闭塞;36例(22.8%)颅内外动脉均正常,全部为后循环TIA组。②32例前循环TIA患者中,28例有颈内动脉系统责任动脉狭窄,符合率为87.5%;126例后循环TIA患者中,66例有椎-基底动脉系统责任动脉狭窄,符合率为52.4%;差异有统计学意义,P<0.01。③以Willis环交通动脉代偿率最高,可达81.0%(128/158),软脑膜代偿率10.1%(16/158),颈外动脉代偿率6.3%(10/158),前、后循环组TIA患者各级侧支代偿方式差异无统计学意义,P>0.05。18例患者的侧支循环代偿途径≥2种,其中4例为前循环TIA,均为症状与DSA符合者;14例为后循环TIA,其中8例为症状与DSA不符合者。结论前循环TIA较后循环TIA者临床症状与责任病变血管的符合率高,且均以Willis环代偿为主。

Relationship between the clinical manifestations of transient ischemic attack and the responsible ves- sels and its collateral circulation

Objective To investigate the relationship between the clinical symptoms of transient ische- mic attack （TIA） and the findings of digital subtraction angiography （DSA） images Methods A total of 158 patients with TIA who performed cerebral digital subtraction angiography （DSA） within 1 to 7 clays after symptom onset were enrolled in the study. The patients were divided into either an anterior circulation TIA group or a posterior circulation TIA group according to the clinical symptoms. Cerebral artery stenoses, estab- lishment of collateral circulation as well as the consistence of clinical symptoms and guilty arteries of the pa- tients in both groups were analyzed. Results Of the 158 patients, the clinical symptoms of 32 were anterior circulation TIA and 126 were posterior circulation TIA. 122 patients （77.2%） had extracranial and intracra- nial artery stenosis or occlusion; the extracranial and intracranial arteries of the 36 patients （22.8%） were normal, and they were all the patients of posterior circulation TIA group. （~）In the 32 patients with anterior circulation TIA, 28 had guity artery stenosis in the internal carotid artery system, and the compliance rate was 87.5%; in the 126 patients with posterior circulation TIA, 66 had guilty artery stenosis in the verte- brobasilar system, and the compliance rate was 52.4%. The difference was statistically significant （ P 〈 0.01 ）. （~The compensatory rate of communicating artery of the circle of Willis was the highest in 158 pa- tients, up to 81.0% （128/158）. The compensatory rate of leptomeningeal collateral circulation was 10.1% （16/158） , and the compensatory rate of the external carotid artery collateral circulation was 6.3% （10/158 ）. There were no significant differences in the modes of all levels of collateral circulation between the an- terior circulation TIA and posterior circulation TIA patients （P 〉0.05 ）. The collateral circulation of 18 pa- tients had 2 or more approaches, 4 of them were anterior circulation TIA, and all the symptoms of the pa- tients and DSA were consistent. Fourteen patients were posterior circulation TIA, 8 of them the symptoms were not consistent with DSA. Conclusion In the aspects of cerebral artery stenosis of anterior or posterior circulation and their clinical symptom consistent rate with TIA, the anterior circulation TIA is higher than the posterior circulation TIA. There is no significant differences in the incidence of each level of collateral circu- lation between posterior circulation TIA and anterior eirculation TIA. The compensatory incidence of circle of Willis is the highest.