Sustaining cerebral perfusion in intracranial atherosclerotic stenosis: The roles of antegrade residual flow and leptomeningeal collateral flow
Sustaining cerebral perfusion in intracranial atherosclerotic stenosis: The roles of antegrade residual flow and leptomeningeal collateral flow
复制标题
颅内动脉粥样硬化性狭窄中维持脑灌注：顺行残余血流和软脑膜侧支血流的作用。
DOI：
10.1177/0271678x18805209
复制
发表时间：
2020-01-01
影响因子：
6.3
通讯作者：
Leung, Thomas W.
中科院分区：
文献类型：
--
作者：
Lan, Linfang;Leng, Xinyi;Leung, Thomas W.
我们的目的是研究顺行残余血流和软脑膜侧支血流在维持颅内动脉粥样硬化性狭窄（ICAS）远端脑灌注中的作用。入组了有症状的大脑中动脉（MCA）-M1狭窄远端脑灌注明显正常的患者。基于CT血管造影建立计算流体动力学模型，以获得跨病变压力比（PR）来测量剩余的前向性血流。在CT血管造影上对软脑膜侧支（LMC）进行分级。在CT灌注图中获得脑灌注度量。在83例患者中，线性回归分析显示，跨病灶PR和LMC量表与相对病灶平均通过时间（rMTT）独立相关。亚组分析显示，在中度（50-69%）MCA狭窄的患者中，病灶内rMTT与跨病灶PR（p < 0.001）而不是LMC评分显着相关，然而，在重度（70-99%）狭窄的患者中，这仅与LMC评分显着相关（p = 0.051）。顺行残余血流和软脑膜侧支血流在维持ICAS远端的脑灌注方面具有互补作用，而在严重狭窄的患者中，脑灌注可能更多地依赖于侧支循环。
We aimed to investigate the roles of antegrade residual flow and leptomeningeal collateral flow in sustaining cerebral perfusion distal to an intracranial atherosclerotic stenosis (ICAS). Patients with apparently normal cerebral perfusion distal to a symptomatic middle cerebral artery (MCA)-M1 stenosis were enrolled. Computational fluid dynamics models were built based on CT angiography to obtain a translesional pressure ratio (PR) to gauge the residual antegrade flow. Leptomeningeal collaterals (LMCs) were scaled on CT angiography. Cerebral perfusion metrics were obtained in CT perfusion maps. Among 83 patients, linear regression analyses revealed that both translesional PR and LMC scale were independently associated with relative ipsilesional mean transit time (rMTT). Subgroup analyses showed that ipsilesional rMTT was significantly associated with translesional PR (p < 0.001) rather than LMC scale in those with a moderate (50-69%) MCA stenosis, which, however, was only significantly associated with LMC scale (p = 0.051) in those with a severe (70-99%) stenosis. Antegrade residual flow and leptomeningeal collateral flow have complementary effects in sustaining cerebral perfusion distal to an ICAS, while cerebral perfusion may rely more on the collateral circulation in those with a severe stenosis.