症状性颅内动脉闭塞患者脑灌注缺损与侧支循环的相关性研究

doi:10.3969/j.issn.1673-5765.2021.05.002

摘要/Abstract

摘要：

目的研究症状性颅内动脉闭塞患者脑灌注缺损与侧支循环的关系。方法回顾性纳入2017年1月-2018年10月于解放军总医院第一医学中心连续收治的症状性单侧颈内动脉（internal carotid artery，ICA）颅内段或大脑中动脉（middle cerebral artery，MCA）M1/M2段闭塞患者，根据闭塞部位分为ICA闭塞组和MCA闭塞组。收集患者临床资料并记录影像学特征，采用定量分析软件获取患侧脑血流残余功能达峰时间（time to maximum of the residual function，Tmax）>4 s和 Tmax>6 s的低灌注区容积，并采用多时相CTA 6级评分法对侧支循环进行评分。比较两组患者低灌注区容积与侧支循环的差异，并分析低灌注区容积与侧支循环评分的相关性。结果最终纳入42例患者，平均年龄54.9±13.9岁，男性29例（69.0%），其中I CA闭塞组19例，MCA 闭塞组23例。ICA闭塞组Tmax>4 s容积（163.1±98.6 mL vs 64.6±54.2 mL，P <0.001）、Tmax>6 s容积（92.4±87.1 mL vs 13.0±27.6 mL，P <0.001）均大于MCA闭塞组；ICA闭塞组侧支循环评分低于MCA闭塞组[3（2～4）分 vs 4（3～4）分，P =0.021]。ICA闭塞组Tmax>4 s 、Tmax>6 s容积与侧支循环评分呈负相关（r =-0.667，P =0.002；r =-0.717，P <0.001）；MCA闭塞组Tmax>4 s 、Tmax>6 s容积与侧支循环评分呈负相关（r =-0.498，P =0.016；r =-0.494，P =0.017）。结论症状性颅内动脉闭塞患者低灌注区容积与闭塞部位及侧支循环相关，ICA闭塞患者较MCA闭塞患者有更大的低灌注缺损和更差的侧支循环。

文章导读： 症状性颅内动脉闭塞患者的灌注缺损严重程度与侧支循环状态及病变部位有关。本研究结果有助于临床针对症状性颅内动脉闭塞患者进行风险评估。

关键词: 缺血性卒中; 颅内动脉闭塞; 血流动力学; 低灌注; 侧支循环

Abstract:

Objective To explore the relationship between perfusion defect and collateral circulation in patients with symptomatic intracranial artery occlusion. Methods This retrospective analysis enrolled the patients with symptomatic unilateral intracranial artery occlusion who were admitted to the First Medical Center of Chinese PLA General Hospital from January 2017 to October 2018. The occluded intracranial arteries included internal carotid artery (ICA) and middle cerebral artery (MCA) M1/M2 segment. The patients were divided into ICA group and MCA group. Clinical and imaging data were collected. The volume of hypoperfusion areas which was defined as Tmax>4 s or Tmax>6 s were obtained by auto-quantitative software. Collateral circulation score was assessed based on multiphase CTA. The hypoperfusion area volume and collateral circulation score were compared between the two groups, and the correlation between hypoperfusion area volume and collateral circulation score in the two groups were analyzed. Results A total of 42 patients were included in this study, with an average age of 54.9±13.9 years and 29 males (69.0%), including 19 patients with ICA occlusion and 23 with MCA occlusion. The volume of hypoperfusion areas in ICA group was larger than that in MCA group (Tmax>4 s: 163.1±98.6 mL vs 64.6±54.2 mL, P <0.001; Tmax>6 s: 92.4±87.1 mL vs 13.0±27.6 mL, P <0.001). The collateral circulation score were lower in ICA group than that in MCA group [3 (2-4) vs 4 (3-4), P =0.021]. The volume of hypoperfusion areas was negatively correlated with collateral circulation score in ICA group (Tmax>4 s: r =-0.667, P =0.002; Tmax>6 s: r =-0.717, P <0.001, respectively); both of them also showed negative correlation in MCA group (Tmax>4 s: r =-0.498, P =0.016; Tmax>6 s: r =-0.494, P =0.017, respectively). Conclusions The volume of hypoperfusion area was associated with collateral circulation and the site of artery occlusion in patients with symptomatic intracranial artery occlusion. Patients with ICA occlusion showed larger hypoperfusion area and poorer collateral circulation compared with those with MCA occlusion.

Key words: Ischemic stroke; Intracranial artery occlusion; Hemodynamics; Hypoperfusion;Collateral circulation

韩东山，吕晋浩，林澜，王柳仙，罗春材，张森皓，魏梦婷，王馨蕊，林家骥，娄昕. 症状性颅内动脉闭塞患者脑灌注缺损与侧支循环的相关性研究[J]. 中国卒中杂志, 2021, 16(05): 427-432.

HAN Dong-Shan, LYU Jin-Hao, LIN Lan, WANG Liu-Xian, LUO Chun-Cai, ZHANG Sen-Hao,WEI Meng-Ting, WANG Xin-Rui, LIN Jia-Ji, LOU Xin. Association between Perfusion Defect and Collateral Circulation in Patients with Symptomatic Intracranial Artery Occlusion[J]. Chinese Journal of Stroke, 2021, 16(05): 427-432.

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