Compensatory patterns of collateral flow in stroke patients with unilateral and bilateral carotid stenosis.
Compensatory patterns of collateral flow in stroke patients with unilateral and bilateral carotid stenosis.
复制标题
脑卒中单侧和双侧颈动脉狭窄患者侧支血流代偿模式
DOI：
10.1186/s12883-016-0560-0
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发表时间：
2016-03-18
期刊：
影响因子：
2.6
通讯作者：
Chen XY
中科院分区：
文献类型：
--
作者：
Fang H;Song B;Cheng B;Wong KS;Xu YM;Ho SS;Chen XY
研究背景侧支循环在维持颈动脉狭窄患者足够的脑血流中起重要作用。我们的目的是评估血流动力学模式与颈动脉狭窄在急性脑卒中patients. MethodsConcrete 586中风患者在医院为基础的队列包括在本研究中。进行颈动脉多普勒超声检查，以确定颈内动脉（ICA）绝对最小直径缩小50%或以上的患者。采用彩色速度成像定量超声（CVIQ）检测双侧颈总动脉（CCA）和椎动脉（VA）颅外段动脉血流量（BFV）。结果586例急性缺血性脑卒中患者（平均年龄67.5 ± 12.4岁）中，ICA狭窄112例（19.1%），其中单侧伊卡81例（13.8%），双侧伊卡31例（5.3%）。单侧伊卡狭窄患者对侧CCA的BFV显著高于同侧CCA（325.5 ± 99.8mL/min vs.242.2 ± 112.2mL/min，P< 0.001）。双侧伊卡狭窄组双侧VA BFV之和占全脑血流量的22%，明显高于无伊卡狭窄组（14.8%，P< 0.001）或单侧伊卡狭窄（16.9%，P= 0.007）。结论单侧颈动脉狭窄患者，对侧颈动脉血流量增加，以补偿减少的血流量，而后循环可以补偿双侧颈动脉狭窄患者脑灌注的减少。
BackgroundCollateral pathways are important in maintaining adequate cerebral blood flow in patients with carotid stenosis. We aimed to evaluate the hemodynamic patterns in relation to carotid stenosis in acute stroke patients.MethodsConsecutive 586 stroke patients in a hospital based cohort were included in the present study. Carotid duplex was performed to identify patients with absolute minimal diameter reductions of 50 % or greater in their internal carotid arteries (ICAs). Color velocity imaging quantification ultrasound (CVIQ) was used to measure extracranial arterial blood flow volume (BFV) in bilateral common carotid arteries (CCAs) and bilateral vertebral arteries (VAs). The absolute values of BFV and the ratios were compared between patients with and without ICA stenosis.ResultsAmong 586 acute ischemic stroke patients (mean age: 67.5 ± 12.4y), ICA stenosis was detected in 112 patients (19.1 %), including unilateral ICA stenosis in 81 patients (13.8 %) and bilateral ICA stenosis in 31 patients (5.3 %). Among patients with unilateral ICA stenosis, the BFV in contralateral CCA was significantly higher than that in ipsilateral CCA (325.5 ± 99.8 mL/min vs. 242.2 ± 112.2 mL/min,P< 0.001). Among patients with bilateral ICA stenosis, the sum of BFV in bilateral VAs accounted for 22 % of the whole cerebral blood flow, which was significantly higher than that in those without ICA stenosis (14.8 %,P< 0.001) or with unilateral ICA stenosis (16.9 %,P= 0.007).ConclusionsIn patients with unilateral carotid stenosis, contralateral carotid blood flow increases to compensate decreased blood flow, while posterior circulation may compensate for the decreased brain perfusion in those with bilateral carotid stenosis.