颅内外动脉重度狭窄或闭塞患者的侧支循环途径

摘要

Objective To study the collateral circulation pathways in patients with severe intra-and extra-cranial artery stenosis or occlusion. Methods Collateral circulation change was assessed by TCD in 100 patients with severe intra-and extra-cranial artery stenosis or occlusion. Results TCD showed piamatral anastomosis of the open collateral circulation pathways in 34(57. 6%)out of the 59 patients with severe stenosis or occlusion of the main cerebral middle artery. Among the 30 patients with severe initial internal carotid artery portion stenosis or occlusion,open collateral circulation pathways were found in 24(80. 0%),including anterior communicating artery collateral circulation pathway in 8,posterior communicating artery collateral circulation pathway in 2,simultaneous anterior and posterior communicating artery collateral circulation pathway in 4,ophthalmic artery collateral circulation pathway in 6, simultaneous anterior and posterior communicating artery and ophthalmic artery collateral circulation pathway in 4. In addition, TCD showed the steal waveform in 4(57. 1%) of the 7 patients with severe subclavian artery stenosis,including proximal vertebral artery occlusion in 3, open external carotid collateral circulation pathway-vertebral artery circulation pathway in 2 with ihe initial vertebral artery portion occlusion,left common carotid artery occlusion accompanying moderate brachiocephalic trunk stenosis in 1. The sequence of collateral circulation pathways was open vertebral artery-external carotid artery-internal carotid artery collateral circulation pathways. Conclusion TCD contributes to the understanding of collateral circulation pathways in patients with severe intra-and extra-cranial artery stenosis or occlusion.%目的 探讨颅内外动脉重度狭窄或闭塞患者的侧支循环途径.方法 对100例老年颅内外动脉重度狭窄或闭塞患者,采用经颅多普勒超声(TCD)技术评估侧支循环变化.结果 大脑中动脉主干重度狭窄或闭塞59例,TCD显示软脑膜吻合侧支通路开放34例,占57.6％.颈内动脉起始部重度狭窄或闭塞30例,侧支通路开放24例,占80.0％,其中前动脉交通侧支开放8例,后动脉交通侧支开放2例,前动脉交通与后动脉交通侧支同时开放4例,眼动脉侧支开放6例,前动脉交通、后动脉交通和眼动脉侧支同时开放4例.锁骨下动脉重度狭窄7例,TCD发现窃血改变4例,占57.1％.椎动脉重度狭窄或闭塞3例中,2例椎动脉起始部闭塞患者出现颈外动脉-推动脉侧支开放.左侧颈总动脉闭塞伴头臂干中度狭窄1例,TCD显示椎动脉-颈外动脉-颈内动脉侧支通路开放.结论 TCD技术有助于了解颅内外动脉重度狭窄或闭塞患者的侧支循环途径.