单侧颈内动脉闭塞患者的颅内侧支循环代偿与脑缺血发生的相关性

目的探讨单侧颈内动脉颅外段闭塞患者颅内侧支循环代偿与脑缺血发生的关系。方法对82例颈动脉彩超发现单侧颈内动脉颅外段闭塞患者,根据临床有无前循环脑缺血症状和神经功能障碍定位体征分为无症状组(38例)和有症状组(44例)。采用经颅多普勒(TCD)检测82例患者侧支循环开放情况及大脑中动脉的平均血流速度。结果无症状组均出现侧支循环开放(100%),无症状组侧支循环开放率高于有症状组(80%),以2个或3个侧支联合开放为主。无症状组的前交通动脉(ACOA)开放率明显高于有症状组(P<0.05);无症状组中ACOA开放率明显高于后交通动脉(PCOA),眼动脉(OA)侧支开放(P<0.05)。无症状组患者大脑中动脉平均血流速度明显高于有症状组。结论单侧颈内动脉闭塞患者颅内侧支循环代偿与脑缺血的发生密切相关,联合代偿对颈内动脉闭塞患者颅内供血的代偿与临床预后至关重要,ACOA的开放是颈内动脉闭塞患者最主要的代偿途径。

The relationship between the collateral circulation and ischemic brain lesion in patients with unilateral internal carotidartery occlusion

Objective To approach the collateral circulation and ischemic brain lesion in patients with unilateral internal carotidartery occlusion. Methods All of 82 patients with unilateral internal carotidartery occlusion those were found by ul trasonography were divided into two groups （unilateral internal carotidartery occlusion with symptomatic and unilateral inter- nal carotidartery occlusion without symptomatic）. Collateral circulation pathway in circle of Willis and the mean flow ve- locity of the middle cerebralartries were measured by TCD. Results The patients with collateral circulation in asymptomatic group was 100% （most of them with two or three collateral eireulations）,which was higher than that in symptomatic group （P 〈 0.05）. Collateral patency of anterior communicating artery in asymptomatic group was higher than that in symptomatic group （P 〈 0.05）. The mean flow velocity of the middle cerebralartries in asymptomatic group was significantly higher than that in symptomatic group. Conclusion The collateral circulation in patients with unilateral internal carotidartery occlusion was closely associated with ischemic brain lesion.Two or more collateral pathways were the important compensation. Collat- eral patency of anterior communicating artery was the most important of a11.