A Novel Window Into Human Vascular Remodeling and Diagnosing Carotid Flow Impairment: The Petro-Occipital Venous Plexus.
A Novel Window Into Human Vascular Remodeling and Diagnosing Carotid Flow Impairment: The Petro-Occipital Venous Plexus.
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DOI：
10.1161/jaha.123.031832
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发表时间：
2023-10-17
影响因子：
5.4
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中科院分区：
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动物研究已证实下游狭窄流量减少导致适应性动脉重塑。作者试图确定下游狭窄的向内重塑是否也发生在人类身上，并且可以通过岩骨颈内动脉周围的 Rektorzik 静脉丛 (RVP) 的真空扩张来检测。作者分析了 214 例颅内磁共振成像检查，其中包括对比增强血管壁成像。通过血管壁成像对 RVP 对称性进行定性评估。如果不对称，则在较厚的一侧测量 RVP 厚度 (RVPT)；如果对称，则在随机分配的一侧测量。测量最大狭窄（M1 或颅内颈内动脉）。后交通动脉和 A1 直径（分别 >1.0mm 和 1.5mm）在狭窄附近定义了足够的侧支流出。 72 名患者在 RVPT 测量结果下游出现狭窄。对于没有足够流出的患者（72 例中的 38 例），95.0% RVPT ≥1.0mm 的患者狭窄程度≥50%，而 RVPT <1.0mm 的患者只有 5.6%。对于这 72 名患者，使用多变量回归分析，较高的 RVPT（RVPT ≥1.0mm 与 <1.0mm）和缺乏足够的流出与更大的下游狭窄相关（P<0.001）。对于下游狭窄而没有足够流出的患者，当单侧狭窄时，不对称的RVP增厚与同侧更大的狭窄相关（P<0.001，所有狭窄≥46%），当双侧狭窄时，两侧之间的狭窄差异更大（P=0.005）。当下游狭窄接近 50% 时，通过 RVPT 或 RVP 不对称测量的向内颈内动脉重塑就会发生，除非通过足够大小的后交通动脉或 A1 保留血流，并且可以作为下游狭窄导致血流大幅减少的功能性测量。
Adaptive arterial remodeling caused by flow reduction from downstream stenosis has been demonstrated in animal studies. The authors sought to determine whether inward remodeling from downstream stenosis also occurs in humans and is detectable by ex vacuo expansion of the Rektorzik venous plexus (RVP) surrounding the petrous internal carotid artery. The authors analyzed 214 intracranial magnetic resonance imaging examinations that included contrast‐enhanced vessel wall imaging. RVP symmetry was qualitatively assessed on vessel wall imaging. RVP thickness (RVPT) was measured on the thicker side if asymmetric or randomly assigned side if symmetric. Maximum stenosis (M1 or intracranial internal carotid artery) was measured. Posterior communicating artery and A1 diameters (>1.0 mm and 1.5 mm, respectively) defined adequate collateral outflow when proximal to the stenosis. Seventy‐two patients had stenosis downstream from RVPT measurements. For those without adequate outflow (38 of 72), 95.0% with RVPT ≥1.0 mm had ≥50% stenosis compared with only 5.6% with RVPT <1.0 mm. For these 72 patients, higher RVPT (RVPT ≥1.0 mm versus <1.0 mm) and absent adequate outflow were associated with greater downstream stenosis (P<0.001) using multivariate regression. For patients with downstream stenosis without adequate outflow, asymmetric RVP thickening was associated with greater ipsilateral stenosis (P<0.001, all had ≥46% stenosis) when stenosis was unilateral and greater differences in stenosis between sides (P=0.005) when stenosis was bilateral. Inward internal carotid artery remodeling measured by RVPT or RVP asymmetry occurs as downstream stenosis approaches 50%, unless flow is preserved through a sufficiently sized posterior communicating artery or A1, and may serve as a functional measure of substantial flow reduction from downstream stenosis.