TCD对单侧颈内动脉重度狭窄或闭塞后颅内侧支循环的诊断和预后评价
谢 萍1） 沈雨雯1） 石逸秋1） 惠品晶2） 刘可夫1）
1）南京医科大学附属苏州医院，江苏 苏州 215008 2）苏州大学附属第一医院，江苏 苏州 215008
通信作者：刘可夫
【摘要】 目的 探讨 TCD 对单侧颈内动脉重度狭窄或闭塞后颅内侧支循环的诊断和预后评价的价值。方法 收集超声诊断为一侧颈内动脉重度狭窄或闭塞同时行 TCD 检查评价颅内侧支循环的病例共22 例。根据患侧大脑中动脉（MCA）平均血流速度分组，同时根据磁共振和 CT 病变侧脑梗死范围大小将病例分为 4 级。分析侧支循环出现率以及侧支循环与 MCA 平均血流速度、脑梗死范围的关系。结果 所有病例均检测到侧支循环开放，16 例（73%）前交通动脉开放，16 例（73%）后交通动脉开放，13 例（59%）眼动脉开放。患侧 MCA 平均血流速度正常组 5 例，偏下限组 7 例，减低组 9 例，明显减低组 1 例。病变侧脑梗死范围 1 级 3 例，2 级 7 例，3 级 6 例，4 级 6 例。前交通动脉开放者的患侧 MCA 平均血流速度［（47.4±11.7）cm/s］明显高于无前交通动脉开放者［（35.8±5.0）cm/s，Z=-2.559，P=0.010］。前交通动脉开放者的梗死范围级别（2.4±1.0）明显低于无前交通动脉开放者（3.5±0.5，Z=-2.598，P=0.022）。结论 TCD 在评价单侧颈内动脉重度狭窄或闭塞后颅内侧支循环方面起重要作用，且前交通动脉侧支开放对于评估其预后有较高价值。
【关键词】 经颅多普勒超声；单侧颈内动脉；重度狭窄；闭塞；颅内侧支循环
【中图分类号】 R445.1 【文献标识码】 A 【文章编号】 1673-5110 （2022） 06-0717-06
DOI：10.12083/SYSJ.220489
Transcranial Doppler in the diagnosis and prognostic evaluation of cranial collateral circulation after severe stenosis or occlusion of unilateral internal carotid artery
XIE Ping1） ，SHEN Yufei1） ，SHI Yiqiu1） ，HUI Pinjing2） ，LIU Kefu1）
1）The Affiliated Suzhou Hospital of Nanjing Medical University，Suzhou 215008，China；2）The Affiliated First Hospital of Soochow University，Suzhou 215008，China
Corresponding author：LIU Kefu
【Abstract】 Objective To investigate the value of transcranial Doppler （TCD） in the diagnosis and prognosis of cranial collateral circulation after severe stenosis or occlusion of unilateral internal carotid artery. Methods A total of 22 cases with severe stenosis or occlusion of one side of internal carotid artery diagnosed by ultrasound and TCD were collected. The patients were grouped according to the average flow velocity of the affected middle cerebral artery（MCA）. At the same time，the cases were divided into four grades according to the scope of cerebral infarction on the lesion side of MRI and CT. The incidence of collateral circulation was analyzed，and the relationship between collateral circulation and MCA average flow velocity/the range of cerebral infarction was analyzed. Results Collateral circulation was detected in all cases，16 cases （73%） showed opening of anterior communicating artery，16 cases（73%）showed opening of posterior communicating artery，and 13 cases（59%）showed opening of ophthalmic artery. The average flow velocity of MCA on the affected side was normal in 5 cases，normal low limit in 7 cases，decreased in 9 cases and significantly decreased in 1 case. The range of cerebral infarction on the lesion side was 3 cases in grade 1，7 cases in grade 2，6 cases in grade 3 and 6 cases in grade 4. The mean velocity of MCA（（47.4±11.7）cm/s）in patients with anterior communicating artery opening was significantly higher than that（（35.8±5.0）cm/s）in patients without anterior communicating artery opening（Z=-2.559，P=0.010）. The grade of infarct size（2.4±1.0）in patients with anterior communicating artery opening was significantly lower than that（3.5 ± 0.5）in atients without anterior communicating artery opening （Z=-2.598，P=0.022）. Conclusion TCD plays an important role in evaluating the cranial collateral circulation after severe stenosis or occlusion of the unilateral internal carotid artery. At the same time，the opening of the anterior communicating artery is of high value in improving prognosis.
【Key words】 Transcranial Doppler；Unilateral internal carotid artery；Severe stenosis；Occlusion；Cranial collateral circulation
