362例缺血性脑血管病脑血管狭窄与侧支循环特点分析

摘要

目的 分析脑动脉狭窄的病变特点及侧支循环的模式,探讨脑动脉闭塞或严重狭窄时侧支循环代偿建立的情况与患者神经功能的关系.方法 回顾性分析362例缺血性脑血管病患者资料,全部患者均接受DSA检查.对脑血管狭窄病变的特点及侧支循环与神经功能缺损的关系进行分析.结果 362例缺血性脑血管病患者中,334例共存在716处脑动脉狭窄病变;其中单纯颅内动脉狭窄143例(42.81%),单纯颅外动脉狭窄84例(25.15%),颅内、颅外动脉均存在狭窄107例(32.04%);单纯前循环病变173例(51.80%),单纯后循环病变58例(17.37%),前、后循环联合病变103例(30.84%).300处颅外动脉狭窄中,颈内动脉颅外段狭窄185处(61.67%),椎动脉颅外段狭窄96处(32.00%);416处颅内动脉狭窄中,大脑中动脉狭窄171处(41.11%).脑动脉闭塞且有侧支循环的患者与无侧支循环的患者间NIHSS评分差异有统计学意义.脑梗死与TIA患者责任血管狭窄程度差异无统计学意义(P＞0.05).结论 颅外动脉狭窄好发于颈内动脉颅外段,颅内动脉狭窄好发于大脑中动脉.TIA患者发展为脑梗死的可能性大.%Objective To analyze the characteristics of cerebral artery stenosis and the collateral circulation model, in order to find out the relationship between neurological function and the establish of compensatory collateral circulation.Methods A total of 362 patients with ischemic cerebrovascular disease who underwent DSA were analyzed retrospectively.The characteristics of cerebral artery stenosis and the relationship between collateral circulation and neurologic impairment were analyzed.Results There were 334 cases (totally 716 segments) of cerebral artery stenosis in 362 patients of ischemic cerebrovascular disease.There were 143 cases (42.81％) of pure intracranial artery stenosis, 84 patients (25.15％) of pure extracranial artery stenosis and 107 cases (32.04％) of intracranial and extracranial artery stenosis.There were 173 cases (51.80％) with anterior circulation lesions, 58 patients (17.37％) with posterior circulation lesions and 103 cases (30.84％) with joint disease.There were 300 segments with extracranial artery stenosis, in which 185 segments (61.67％) with extracranial internal carotid artery and 96 segments (32.00％) with extracranial vertebral artery.There were 416 segments with intracranial arterial stenosis, in which 171 segments (41.11 ％) with middle cerebral artery.NIHSS scores in cerebral artery occlusion patients with or without collateral circulation were significantly different.The different between cerebral infarction and TIA patients was not statistical significant (P＜0.05).Conclusion Extracranial artery stenosis often occurred in extracranial internal carotid artery, intracranial arterial stenosis often occurred in middle cerebral artery.TIA patients have high risk for developing to infarction.