前循环缺血颅内侧支循环建立的评价

摘要

目的 研究前循环缺血性脑血管病颅内侧支循环的建立及影响因素.方法 采用数字减影脑血管造影技术(DSA)对153例前循环缺血患者颅内侧支循环代偿情况进行评估,探讨临床类型、颈内动脉狭窄程度和狭窄部位与颅内侧支循环建立的关系.结果 153例患者中脑梗死74例,短暂性脑缺血发作(TIA) 31例,无症状性前循环梗死48例.153例患者中前交通动脉(ACOA)开放67例(43.8％),后交通动脉(PCOA)开放55例,眼动脉(OA)开放9例,软膜动脉(LEP)开放33例.侧支开放率3组无统计学差异(P＞0.05).按颈部血管狭窄程度分为4组:＜50％、50％ ～75％、75％ ～ 99％及闭塞组,ACOA开放率各组中存在统计学差异(P＜0.05).左侧OA在狭窄程度为75％ ～99％时开放率最高(P＜0.05).LEP(LA)、LEP(RP)、LEP(LP)开放率与颈内动脉狭窄程度相关,狭窄程度越高其开放率越高.血管狭窄部位显著影响侧支开放率,混合狭窄组ACOA开放率最高(72％)(P＜0.05).OA开放率与颅外段血管狭窄相关(P＜0.01).LEP(RP)、LEP(LA)、LEP(LP)开放率与混合狭窄相关(P＜0.05).PCOA开放率与狭窄部位无明显统计学差异(P＞0.05).结论 前循环缺血患者存在不同程度的侧支循环开放,以ACOA开放率最高.侧支循环的开放率与血管狭窄程度相关,提示对血管病变的慢性代偿.血管狭窄的部位影响侧支循环的建立.%Objective To investigate the collateral circulation in patients with the anterior circulatory ischemic stroke and its related factors. Methods The establishment of collateral circulation in 153 patients were evaluated by digital subtraction angiography (DSA) , and the possible relationship with clinical types, the degree and position of internal carotid artery stenosis was explored. Results 153 patients included 74 cases with anterior circulation infarction, 31 cases with transient ischemic attack (TIA) and 48 cases with non-cerebrovascular disease. Anterior communicating artery ( ACOA) opened in 67 cases, the posterior communicating artery ( PCOA) opened in 55 , ophthalmic artery ( OA) opened in 9 , and leptomeninged collateral anastomosis (LEP) opened in 33 patients, respectively. The open rate of ACOA (43. 8% ) was the highest among three groups. All patients were subdivided into four groups based on the stenosis degree of carotid artery: less than 50% , 50%-75% , 75%-99% , and totally occluded. The open rate of ACOA reached statistical difference among four groups (P <0. 05). A relative higher open rate was observed in the patients with a stenosis of 75%-99%. The open rates of LEP ( LA) , LEP ( RP) , LEP ( LP) were significantly related with the degree of carotid stenosis, with a tendency that the more severe the carotid artery stenosis, the higher the open rate was. The position of carotid artery stenosis significantly affected the open rates of collateral circulation. The open rate of ACOA was relatively higher in the intracranial combining extracranial stenosis (72% ). The open rate of OA was significantly related with extracranial artery stenosis, while that of LEP ( RP, LP, LA) was significantly related with intracranial combining extracranial stenosis (P <0. 05) . Conclusions The collateral circultion was opened to some extent in patients with anterior circulatory stroke, with the highest open rate in ACOA. The open rate of the collateral circulation was associated with the degree of carotid artery stenosis, which indicates a chronic compensation to the carotid artry stenosis. The sites of carotid stenosis possibly affect the estabolishment of collateral circulation.