Collateral circulation in symptomatic intracranial atherosclerosis
Collateral circulation in symptomatic intracranial atherosclerosis
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DOI：
10.1038/jcbfm.2010.224
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发表时间：
2011-05-01
影响因子：
6.3
通讯作者：
Chimowitz, Marc I.
中科院分区：
文献类型：
--
作者：
Liebeskind, David S.;Cotsonis, George A.;Chimowitz, Marc I.
颅内动脉粥样硬化的侧支循环从未被系统地描述过。我们在一项症状性颅内动脉粥样硬化疾病的多中心试验中研究了侧支循环。对基线血管造影进行了审查，以了解颈内动脉、大脑中动脉、椎动脉和基底动脉狭窄侧支循环的信息。一组血管造影量表用于评价病变部位、动脉通畅性、顺行血流、下游区域灌注和侧支循环，对所有其他数据均设盲。在近端动脉狭窄范围为50%-99%的287/569例（50%）受试者中，侧支循环可充分用于分析。侧支循环的范围在69%中不存在或没有，在10%中缓慢或最小，在7%中更快速但区域灌注不完全，在11%中完全但延迟灌注，以及在4%中快速，完全侧支循环灌注。侧支血流的范围与狭窄百分比相关（P < 0.0001），狭窄越严重，侧支代偿越大。总的来说，侧支循环分级随着穿过病变的前向血流（心肌缺血时的血栓溶解）和由此产生的下游灌注（脑梗死时的血栓溶解）的减少而增加（均P < 0.001）。我们的研究结果提供了各种狭窄的侧支血管的初步详细描述，表明侧支血管灌注是颅内动脉粥样硬化病理生理学的关键组成部分，并暗示需要在正在进行的研究中进一步评估。Journal of Cerebral Blood Flow & Metabolism（2011）31，1293-1301; doi：10.1038/jcbfm.2010.224; 2010年12月15日在线发表
Collateral circulation in intracranial atherosclerosis has never been systematically characterized. We investigated collaterals in a multicenter trial of symptomatic intracranial atherosclerotic disease. Baseline angiography was reviewed for information on collaterals in stenoses of the internal carotid, middle cerebral, vertebral, and basilar arteries. A battery of angiographic scales was utilized to evaluate lesion site, arterial patency, antegrade flow, downstream territorial perfusion, and collateral circulation, blinded to all other data. Collateral circulation was adequately available for analysis in 287/569 (50%) subjects with proximal arterial stenoses ranging from 50% to 99%. Extent of collaterals was absent or none in 69%, slow or minimal in 10%, more rapid, yet incomplete perfusion of territory in 7%, complete but delayed perfusion in 11%, and rapid, complete collateral perfusion in 4%. Extent of collateral flow correlated with percentage of stenosis (P < 0.0001), with more severe stenoses exhibiting greater compensation via collaterals. Overall, collateral grade increased with diminished antegrade flow across the lesion (thrombolysis in myocardial ischemia) and resultant downstream perfusion (thrombolysis in cerebral infarction) (both P < 0.001). Our findings provide the initial detailed description of collaterals across a variety of stenoses, suggesting that collateral perfusion is a pivotal component in pathophysiology of intracranial atherosclerosis and implicating the need for further evaluation in ongoing studies. Journal of Cerebral Blood Flow & Metabolism(2011) 31, 1293-1301; doi:10.1038/jcbfm.2010.224; published online 15 December 2010