颈内动脉重度狭窄或闭塞患者侧支循环对脑梗死的影响

目的 探讨颈内动脉重度狭窄或闭塞患者侧支循环的状况与脑梗死的关系。方法 将脑血管造影发现颈内动脉狭窄〉70％的患者62例（6例闭塞）分为有症状组（41例）和无症状组（21例），根据头部MRI上梗死灶的部位、大小和形状，将梗死灶分为小穿支动脉供血区梗死、大穿支动脉供血区梗死、皮质支动脉供血区梗死、大面积梗死及分水岭区梗死。通过观察Willis环的完整性及其他次级侧支循环途径，分析侧支循环与脑梗死的关系。结果 ①有症状组患者在MRI上均有脑梗死灶，表现为小穿支动脉供血区梗死8例、大穿支动脉供血区梗死6例、分水岭区梗死10例，大、小穿支动脉供血区同时梗死9例、穿支动脉供血区梗死合并分水岭区梗死4例、皮质支动脉供血区梗死2例、大面积梗死2例；在无症状组，有分水岭区梗死1例、穿支动脉供血区梗死合并分水岭区梗死7例，其余13例无梗死灶。②有症状组中，Willis环前、后循环均完整5例、前半循环完整12例、后半循环完整8例、前后循环均不完整16例；无症状组中，Willis环前、后循环均完整14例、前半循环完整4例、后半循环完整2例、前后循环均不完整1例。症状组Willis环的开放程度均低于无症状组，差异有统计学意义（P〈0．01）。③症状组次级侧支代偿——眼动脉、大脑前动脉和大脑后动脉的皮质支侧支代偿分别为3、8和5例，无症状组分别为1、6和3例。两组比较，差异无统计学意义（P〉0．05）。结论 颈内动脉重度狭窄或闭塞患者是否出现脑梗死与Willis环开放的程度有关，可能与次级侧支代偿途径无关。

Effect of collateral circulation on cerebral infarction in patients with severe internal carotid artery stenosis or occlusion

Objective To investigate the relationship between the status of collateral circulation and cerebral infarction in patients with severe internal carotid artery stenosis or occlusion. Methods Sixty-two patients with internal carotid artery stenosis 〉70% （6 patients had occlusion） detected by cerebral angiography were divided into symptomatic group （ n = 41 ） and asymptomatic group （ n = 21 ）. The infarctions were divided into small perforating artery infarction, large perforating artery infarction, cortical artery territory infarction, massive cerebral infarction, and watershed-zone infarction according to the location, size and shape of infarction on brain MRI. The relationship between collateral circulation and cerebral infarction was analyzed by observing the integrity of the circle of Willis and other collateral pathways. Results ①In the symptomatic group, 8 patients had small perforating artery infarction, 6 had large perforating artery infarction, 9 bad both small and large perforating artery infarction; 2 had cortical artery territory infarction, and 2 had massive cerebral infarction. Ten patients had watershed-zone infarction, and 4 had perforating artery infarction complicated with watershed-zone infarction. In the asymptomatic group, 1 patient had watersbed-zone infarction, 7 had perforating artery infarction complicated with watershed-zone infarction, and 13 had no infarction. ②In the symptomatic group, 5 patients had integrated anterior and posterior Willis circle, 12 had integrated anterior part of Willis circle, 8 had integrated posterior part of Willis circle, and 16 both the anterior and posterior pan of Willis circle were not integrated. In the asymptomatic group, 14 patients had integrated anterior and posterior circle of Willis, 4 had integrated anterior part of Willis circle, 2 had integrated posterior part of Willis circle, and 1 both the anterior and posterior part of Willis circle were not integrated. The degree of patency of the Willis circle in the symptomatic group was le