CEREBRAL HEMODYNAMICS IN ISCHEMIC CEREBROVASCULAR-DISEASE
CEREBRAL HEMODYNAMICS IN ISCHEMIC CEREBROVASCULAR-DISEASE
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DOI：
10.1002/ana.410290302
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发表时间：
1991-03-01
影响因子：
11.2
通讯作者：
POWERS, WJ
中科院分区：
文献类型：
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作者：
POWERS, WJ
在过去的十年中，技术的进步使得测量个体患者的局部脑血流动力学成为可能。 用这些技术进行的研究表明，颈动脉狭窄的程度与同侧脑循环的血流动力学状态相关性很差。 在这些情况下，脑灌注压和血流量的主要决定因素是侧支循环通路的充分性。 由于侧支循环因患者而异，因此不存在持续产生脑循环血流动力学损害的颈动脉狭窄的临界程度。 因此，是时候放弃血流动力学意义上的颈动脉狭窄的概念，因为它涉及到脑血管疾病的发病机制和治疗。 局部脑血流动力学的测量为短暂性脑缺血发作的发病机制提供了新的见解，并产生了一些关于局部脑灌注压慢性降低的预后和治疗重要性的初步数据。 进一步研究血流动力学因素在缺血性卒中中的重要性，现在可以基于在其他共存的流行病学、临床、血液学和血管造影危险因素的背景下对脑（而不是颈动脉或椎基底动脉）血流动力学的准确评估。
During the past decade, technological advances have made it possible to measure regional cerebral hemodynamics in individual patients. Studies performed with these techniques have demonstrated that the degree of carotid stenosis correlates poorly with the hemodynamic status of the ipsilateral cerebral circulation. The primary determinant of cerebral perfusion pressure and blood flow under these circumstances is the adequacy of collateral circulatory pathways. Since collateral circulation varies from patient to patient, there is no critical degree of carotid stenosis that consistently produces hemodynamic compromise of the cerebral circulation. It is, thus, time to abandon the concept of the hemodynamically significant carotid stenosis as it relates to the pathogenesis and treatment of cerebrovascular disease. Measurements of regional cerebral hemodynamics have provided new insight into the pathogenesis of transient ischemic attacks and generated some preliminary data on the prognostic and therapeutic importance of chronic reductions in regional cerebral perfusion pressure. Further investigations into the importance of hemodynamic factors in ischemic stroke can now be based on accurate assessment of cerebral (not carotid or vertebrobasilar) hemodynamics in the context of other coexisting epidemiological, clinical, hematological, and angiographic risk factors.