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目的分析颈内动脉(ICA)重度狭窄或闭塞后颈总动脉(CCA)与大脑中动脉(MCA)血流动力学的改变,以及侧支循环开放情况,以提高经颅多普勒超声(TCD)对ICA重度狭窄或闭塞检测的准确性。方法选择经全脑数字减影血管造影(DSA)检查证实一侧ICA重度狭窄或闭塞且双侧CCA和MCA正常或狭窄<50%的患者30例。全部行TCD检查,测量双侧CCA和MCA的收缩期血流速度(Vs),平均血流速度(Vm)和搏动指数(PI)。并与DSA对比,分析TCD判断侧支循环的敏感性及特异性。结果 (1)ICA狭窄或闭塞侧CCA的Vm和Vs均较无病变侧明显降低(P<0.05)。病变侧PI较无病变侧明显增高(P<0.05)。(2)ICA狭窄或闭塞侧MCA的Vm、Vs和PI均较无病变侧明显降低(P<0.05)。(3)TCD检测前交通动脉(ACoA)开放占66.7%(20/30),后交通动脉(PCoA)开放占60.0%(18/30),颈内-外动脉侧支循环开放占43.3%(13/30)。与DSA结果相比较TCD显示侧支循环的敏感性为90%,特异性为85%。结论 TCD检查CCA和MCA的血流动力学变化及侧支循环开放情况对ICA重度狭窄或闭塞的准确诊断具有重要指导价值。
Objective To analyze the hemodynamic changes of the common carotid artery (CCA) and the middle cerebral artery (MCA) after severe stenosis or occlusion of the internal carotid artery (ICA) and the opening of collateral circulation in order to improve the transcranial Doppler echocardiography (TCD) ) For the accuracy of ICA stenosis or occlusion detection. Methods Thirty patients with severe ICA stenosis or occlusion on one side and normal or stenosed bilateral CCA and MCA <50% were selected by whole brain digital subtraction angiography (DSA). All patients underwent TCD examinations and measured systolic blood flow velocity (Vs), mean blood flow velocity (Vm) and pulsatility index (PI) on bilateral CCA and MCA. And compared with DSA, TCD to determine the sensitivity and specificity of collateral circulation. Results (1) The Vm and Vs of ICA on the stenosis or occlusion side of ICA were significantly lower than those on the non-lesion side (P <0.05). The lesion PI was significantly higher than the non-lesion side (P <0.05). (2) Vm, Vs and PI of stenosis or occlusion MCA in ICA were significantly lower than those in non-lesion side (P <0.05). (3) The opening of ACoA before TCD accounted for 66.7% (20/30), the posterior communicating artery (PCoA) opened 60.0% (18/30), the internal carotid-external artery collateral circulation accounted for 43.3% 13/30). TCD showed a sensitivity of 90% and a specificity of 85% for collateral circulation as compared with DSA results. Conclusion TCD examination of CCA and MCA hemodynamic changes and open collateral circulation for the diagnosis of ICA severe stenosis or occlusion has important guiding value.