临床颈动脉系统TIA患者的脑血管造影分析

目的:以数字减影脑血管造影为手段,分析颈动脉系统TIA患者脑供血动脉狭窄或闭塞的分布、程度以及侧枝循环建立情况。方法:颈动脉系统TIA患者70例均行脑血管造影检查,包括主动脉弓上造影及至少双侧颈总及锁骨下动脉四根血管造影。明确有无脑供血动脉的狭窄、狭窄的位置、程度及侧枝循环情况。结果:62例患者存在脑供血动脉狭窄或闭塞,共检出病变132处,轻度狭窄40处(30.3%),中度狭窄34处(25.8%),重度39处(29.5%),闭塞19处(14.4%)。可判断责任血管者58例(85.0%):单纯前循环45例,前后循环联合病变有13例。以颈内动脉狭窄80处为对象,研究颈内动脉狭窄或闭塞的侧枝循环情况。汇总邻近可能引起同一侧枝循环通路的病变,共分析病变58处,发现合并侧枝的病变有23处,有侧支数量36处。各种侧支循环中,Willis环出现频度最高,包括前交通代偿13处和后交通代偿5处。其次为软膜血管代偿13处。结论:颈动脉系统TIA患者,颅外血管病变多于颅内血管病变。责任血管不单纯是在前循环,还可以是前后循环联合病变。颈内动脉狭窄或闭塞最常见的侧枝循环是Wlliis环和软脑膜血管,严重的脑供血动脉狭窄更易引发侧枝循环建立。

The analysis of digital subtraction angiography in patients with transient carotid artery ischemic attack

Objective:To investigate the characteristics in Chinese Patients with transient carotid artery ischemic attack by digital subtraction angiographies(PSA).We focused on the distribution,degree of cervicocranial artery stenosis or occlusion and the patterns of collateral circulation.Methods:A retrospective analysis was conducted of a total of 70 Patients with transient carotid artery ischemic attack.All patients were examined by standard cerebral DSA and were identified whether there was cervicocranial artery stenosis.Then the location,degree of the stenosis or occlusion and the pattenrs of collateral circulation would be analyzed.Results:The DSA results were positive in 62 cases(88.6%).the 132 lesions were found and We found 40 mild stenosis(30.3%),34 moderate stenosis(25.8%),39 severe stenosis(29.5%)and 19 occlutions(14.4%).we can identifiy 58 guilty artery,including 45 anterior circulation arterial lesions and 13 anterior-posterior circulation arterial lesions.80 ICA stenosis or occlusion at intracarotid artery were diagnosed determinately by DSA,Removed the stenosis or occlusions which can lead to the same collateral circulation,we focused on the rest 58 lesions.23 lesions led to collateral circulation in these cases,and the 36 collateral pathways were identified :13 through the ACoA,5 through the pCoA,13 through leptomeningeal pathway.Conclusion:The occurrence of extracranial guilty artery is more frequent than that of intracranial guilty artery in patients with transient carotid artery ischemic attack.The guilty artery stenosis including anterior circulation arterial lesions and anterior-posterior circulation arterial lesions.In the study of ICA stenosis or occlusion,the circle of Willis and leptomeningeal pathway are the most frequent collaterals identified by angiography.More severe stenosis lead to more collateral circulations.