一侧颈内动脉重度狭窄或闭塞后前交通动脉开放对另一侧颅内外动脉血流动力学的影响

摘要

目的 研究一侧颈内动脉(ICA)颅外段重度狭窄(狭窄率为70％ ～ 99％)或闭塞后,前交通动脉(ACoA)开放对另一侧颅内、外动脉血流动力学的影响 方法 选择一侧ICA颅外段重度狭窄或闭塞,另一侧ICA颅外段正常或狭窄率＜50％(简称相对正常侧)的患者228例,其中ACoA未开放者115例,开放者113例.采用彩色多普勒血流显像(CDFI)测量双侧ICA颅外段近段管径、收缩期峰值流速(PSV)、舒张期术流速(FDV),血管阻力指数(RI)；经颅多普勒(TCD)测量双侧大脑中动脉(MCA)、大脑前动脉(ACA)的PSV、EDV及血管搏动指数(PI).分析ACoA开放对相对正常侧ICA、MCA、ACA 血流动力学的影响. 结果 ①ACoA未开放组和开放组的相对正常侧的ICA颅外段管径差异无统计学意义.ACoA开放组相对正常侧ICA的PSV、EDV均高于未开放组(P=0.000),RI值低于未开放组(P=0.001).②ACoA开放组相对正常侧的MCA、ACA的PSV和EDV均高于术开放组(P=0.000)、PI值低于术开放组,但两组间仅ACA的PI差异有统计学意义(P=0.007).③相关性分析显示,相对正常侧MCA和ACA的平均血流速度与ICA颅外段的平均血流速度呈正相关关系(r=0.587,r =0.346,P =0.000). 结论 一侧ICA颅外段重度狭窄或闭塞时,ACoA的开放直接影响另一侧ICA颅外段及MCA、ACA的血流动力学变化.%Objective To study the effects of anterior communicating artery ( ACoA) patency on the hemodynamk alteration in contralateral extracranial-intracranial artery after severe stenosis (70% to 99% ) or occlusion of unilateral extraeranial internal carotid artery (ICA). Methods Two hundred twenty-eight patients with severe unilateral ICA stenosis or occlusion and normal or stenosis < 50% (referred to relatively normal) of the contralateral ICA were enrolled in the study. Among them, there were 113 patients with and 115 without patent ACoA. Color Doppler flow imaging (CDR) was used to measure the diameters of bilateral proximal ICA, the peak systolic velocity ( PSV ) , the rnd-iJiasti.lir flow velocity (EDV) , and the vascular resistance index { RI). Transcranial Doppler (TCP) was used to measure the PSV, EDV, and pulsatility index (PI) of the bilateral middle cerebral artery (MCA) and anterior cerebral artery (ACA). The effects of ACoA patency on the hemodynamk-v of ICA . MCA and ACA of the relatively normal side were analyzed. Results ①There was no significant difference in the diameter of ICA on the relatively normal side between the ACoA unpatent group and the ACoA patent group. The PSV and EDV on the relatively normal side in the ACoA patent group were higher than those in the ACoA unpatent group ( P <0.000) while the RI was lower than that in the ACoA unpatent group (P =0.001). ②The PSV and EDV of MCA and ACA on the ICA relatively normal side in the ACoA patent group were higher than those in the ACoA unpatent group (P = 0. 000) and the PI was lower than that in the ACoA unpatent group, however, there was significant difference only in PI of ACA between ihe two groups (P - 0. 007). ③The correlation analysis showed that the mean velocity of MCA and ACA on the relatively normal side was positively correlated with that of ICA (r =0.587, 0.346, P =0.000). Conclusion When one side of ICA is severely stenotic or occlusion , the ACoA patency will direetly influence the hemodynamie alteration of the extracra-nial ICA as well as MCA and ACA on the other side.