颈内动脉闭塞后脑梗死分布与侧支循环代偿的相关性研究

目的探讨颈内动脉闭塞时脑梗死的发生机制及侧支循环对不同部位脑梗死的影响。方法 2009年1月至2010年9月收治急性脑梗死患者45例,均行磁共振弥散成像(DWI)和数字减影血管造影(DSA)检查,证实一侧颈内动脉闭塞并引起同侧新发梗死。记录梗死分布部位及侧支循环开放情况,分析颈内动脉闭塞引起同侧脑梗死的分布特征与前、后交通动脉开放的相关性。结果 45例中,颈内动脉闭塞后梗死分布依次为皮层微小梗死38例(84.4%),内分水岭梗死22例(48.9%),流域性梗死21例(46.7%),后分水岭梗死10例(22.2%),前分水岭梗死6例(13.3%),穿支动脉供血区梗死10例(22.2%)。其中皮层微小梗死合并分水岭梗死23例(60.5%)。前交通动脉开放时无流域性梗死(0%,P=0.013);12例无一级侧支开放者发生流域性梗死11例(91.7%,P=0.003)。结论动脉到动脉栓塞机制与低灌注/栓子清除障碍机制共同参与了颈内动脉闭塞引起的脑梗死。前交通动脉开放可以降低流域性梗死发生率。

The infarction patterns and the compensatory effect of collateral circulation in patients with internal carotid artery occlusion: a correlative study

Objective To investigate the infarction patterns and the collateral circulation in patients with internal carotid artery occlusion with diffusion-weighted imaging and DSA,to analyze the mechanism of stroke caused by internal carotid artery occlusion and to discuss the correlation between the infarction patterns and the compensatory effect of collateral circulation.Methods A total of 45 patients with acute cerebral infarction due to DSA-confirmed unilateral internal carotid artery occlusion,who were admitted to the hospital during the period from Jan.2009 to Sep.2010,were enrolled in this study.Diffusion-weighted imaging and DSA were performed in all patients.The infarction regions and the findings of PCoA/ACoA were recorded,and the ipsilateral infarction patterns were evaluated.The relationship between the infarction patterns and the compensatory effect of collateral circulation was statistically analyzed.Results The ipsilateral infarction patterns caused by internal carotid artery occlusion were classified as small cortical infarcts(84.4%),internal watershed infarcts(48.9%),territory infarcts(46.7%),posterior watershed infarcts(22.2%),anterior watershed infarcts(13.3%),perforating artery infarcts(22.2%).Among them,23 patients had small cortical infarcts together with cerebral watershed infarcts(60.5%).No territory infarcts were found in the patients with patent ACoA(0%,P = 0.013),while 91.7% of the patients showing no patent PCoA and/or ACoA had territory infarcts(11/12,P = 0.003).Conclusion Both artery-to-artery embolism and hypoperfusion with impaired emboli clearance are involved in the mechanism of ipsilateral infarctions caused by internal carotid artery occlusion.Patent ACoA can reduce the incidence of territory infarcts,and it maybe protect patients from territory infarcts.