颈内动脉扭曲的特点及其脑血流动力学变化

摘要

Objective To investigate the characteristics of internal carotid artery (ICA) tortuosity and its cerebral hemodynamics change.Methods Two hundreds and twenty three patients with ischemic cerebrovascular disease were examined by aortocranial angiography and transcranial doppler (TCD).The shape of ICA tortuosity was observed,and patients were divided into ICA tortuosity group and normal group.The cerebral hemodynamics parameters in the two groups were compared.Results The aortocranial angiography showed that ICA tortuosity was in 159 cases (ICA tortuosity group),and bilateral tortuosity in 127 cases (79.9％),unilateral tortuosity in 32 cases (20.1％) ; normal was in 64 patients (normal group).Curving was the most (47.8％) type,kinking was take the second place (36.8％),and coiling was the least (5.3％).The rate of curving in the left side (56.7％) was significantly higher than that in the right side (43.3％) (P ＜ 0.05).Compared with normal group,systolic blood flow velocity,end diastolic velocity,mean velocity,pulsatility index and resistance index in ICA tortuosity group and patients with bilateral kinking were significantly lower (all P ＜ 0.05) ; and there was no statistically significant difference in the bilateral curving patients.Conclusions ICA tortuosity is mainly in curving and kinking.ICA tortuosity and kinking can lead to significantly reduced cerebral hemodynamics,while there was no significant change in ICA curving.%目的 研究颈内动脉(ICA)扭曲的特点及其脑血流动力学变化.方法 对223例缺血性脑血管病患者进行全脑血管造影和经颅多普勒超声检查.观察ICA扭曲的形态,将患者分为ICA扭曲组及正常组.比较两组的脑血流动力学参数.结果 全脑血管造影示ICA扭曲159例(ICA扭曲组),其中双侧扭曲127例(79.9％),单侧扭曲32例(20.1％)；无扭曲64例(正常组).扭曲的类型以迂曲型最多(47.8％),折曲型次之(36.8％),盘曲型最少(5.3％)；其中ICA左侧迂曲率(56.7％)显著高于右侧(43.3％)(P＜0.05).与正常组比较,ICA扭曲组及双侧折曲患者的大脑中动脉的收缩期峰速、舒张末期血流速度、平均血流速度、搏动指数及阻力指数明显降低(均P＜0.05)；双侧迂曲患者各血流动力学参数的差异无统计学意义.结论 ICA扭曲以迂曲型和折曲型为主.ICA扭曲及其折曲型可引起脑血流动力明显降低,迂曲型则无显著改变.