经颅多普勒超声在脑侧支循环评估中的临床应用

doi:10.3969/j.issn.1673-5765.2019.08.010

摘要/Abstract

摘要：

脑侧支循环的建立对于缺血性卒中的预后至关重要，便捷有效的脑侧支循环评估方法对于临床预测卒中患者预后、血管再通治疗效益与风险评价尤为重要。TCD因其可实时检测脑血流动力学指标、无创伤、可重复、操作便捷、廉价等优点在脑侧支循环评估中发挥着不可替代的作用。本文检索文献就TCD对脑一、二级侧支循环和脑血管反应性的检测方法、意义及临床应用进展进行综述，以期为临床诊疗提供帮助。

文章导读： 本文对TCD评估脑侧支循环的方法及其在缺血性卒中风险、不同治疗方式预后的评估等方面的应用价值进行了介绍。

关键词: 经颅多普勒超声; 侧支循环; 缺血性卒中

Abstract:

Cerebral collateral circulation is crucial for the prognosis of patients with acute ischemic stroke (AIS). The assessment of cerebral collateral circulation can guide the selection of treatment strategy. TCD is a convenient and effective method of evaluating collateral circulation. TCD can detect cerebral hemodynamic indexes in real-time, in addition, it has non-invasive, repeatable, convenient operation and low-priced advantages. Therefore, TCD plays an important role in diagnosis and treatment of AIS. This article reviewed the detection methods and clinical value of TCD for primary and secondary collateral circulation and cerebrovascular reactivity in ischemic stroke, to provide some reference for diagnosis and treatment of AIS.

Key words: Transcranial Doppler ultrasound; Collateral circulation; Ischemic stroke

刘玮，卢烁，刘尊敬. 经颅多普勒超声在脑侧支循环评估中的临床应用[J]. 中国卒中杂志, 2019, 14(08): 786-791.

LIU Wei,LU Shuo, LIU Zun-Jing. Assessment of Collateral Circulation in Ischemic Stroke Using Transcranial Doppler Ultrasound[J]. Chinese Journal of Stroke, 2019, 14(08): 786-791.

参考文献

[1] GALEGO O，JESUS-RIBEIRO J，BAPTISTA M，et

al. Collateral pial circulation relates to the degree of

brain edema on CT 24 hours after ischemic stroke[J].

Neuroradiol J，2018，31（5）：456-463.

[2] LIEBESKIND D S，COTSONIS G A，SAVER J

L，et al. Collaterals dramatically alter stroke risk in

intracranial atherosclerosis[J]. Ann Neurol，2011，69

（6）：963-974.

[3] KILBURG C，SCOTT MCNALLY J，DE

HAVENON A，et al. Advanced imaging

in acute ischemic stroke[J/OL]. Neurosurg

Focus，2017，42（4）：E10. https：//doi.

org/10.3171/2017.1.FOCUS16503.

[4] LENG X，FANG H，LEUNG T W，et al. Impact of

collaterals on the efficacy and safety of endovascular

treatment in acute ischaemic stroke：a systematic

review and meta-analysis[J]. J Neurol Neurosurg

Psychiatry，2016，87（5）：537-544.

[5] SHETH S A，LIEBESKIND D S. Collaterals in

endovascular therapy for stroke[J]. Curr Opin Neurol，

2015，28（1）：10-15.

[6] LIEBESKIND D S. Collateral circulation[J]. Stroke，

2003，34（9）：2279-2284.

[7] UEMURA A，O'UCHI T，KIKUCHI Y，et al.

Prominent laterality of the posterior cerebral artery

at three-dimensional time-of-flight MR angiography

in M1-segment middle cerebral artery occlusion[J].

AJNR Am J Neuroradiol，2004，25（1）：88-91.

[8] LIEBESKIND D S，COTSONIS G A，SAVER

J L，et al. Collateral circulation in symptomatic

intracranial atherosclerosis[J]. J Cereb Blood Flow

Metab，2011，31（5）：1293-1301.

[9] WITTKO-SCHNEIDER I M，SCHNEIDER F

T，PLATE K H. Cerebral angiogenesis during

development：Who is conducting the orchestra?[J/

OL]. Methods Mol Biol，2014，1135：3-20. https：//

doi.org/10.1007/978-1-4939-0320-7_1.

[10] HOKSBERGEN A W，LEGEMATE D A，UBBINK

D T，et al. Collateral variations in circle of willis

in atherosclerotic population assessed by means of

transcranial color-coded duplex ultrasonography[J].

Stroke，2000，31（7）：1656-1660.

[11] RIBO M，GARAMI Z，UCHINO K，et al. Detection

of reversed basilar flow with power-motion Doppler

after acute occlusion predicts favorable outcome[J].

Stroke，2004，35（1）：79-82.

[12] MÜLLER M，HERMES M，BRÜCKMANN H，et

al. Transcranial Doppler ultrasound in the evaluation

of collateral blood flow in patients with internal

carotid artery occlusion：correlation with cerebral

angiography[J]. AJNR Am J Neuroradiol，1995，16

（1）：195-202.

[13] KIM Y，SIN D S，PARK H Y，et al. Relationship

between flow diversion on transcranial Doppler

sonography and leptomeningeal collateral circulation

in patients with middle cerebral artery occlusive

disorder[J]. J Neuroimaging，2009，19（1）：23-26.

[14] MAHER S，KHURSHID K. Transcranial Doppler

and transcranial color duplex in defining collateral

cerebral blood flow[J]. J Neuroimag，2018，28（5）：

455-476.

[15] MAYBERG T S，LAM A M，MATTA B F，et a1.

The variability of cerebrovascular reactivity with

posture and time[J]. J Neurosurg Anesthesiol，1996，

8（4）：268-272.

[16] VERNIERI F，PASQUALETTI P，MATTEIS M，

et al. Effect of collateral blood flow and cerebral vasomotor reactivity on the outcome of carotid artery

occlusion[J]. Stroke，2001，32（7）：1552-1558.

[17] FU J H，LU C Z，HONG Z，et al. Relationship

between cerebral vasomotor reactivity and white

matter lesions in elderly subjects without large artery

occlusive disease[J]. J Neuroimaging，2006，16（2）：

120-125.

[18] BØTHUN M L，HAALAND Ø A. Time course

of cerebrovascular reactivity in Patients treated

for unruptured intracranial aneurysms：a one-year

transcranial doppler and acetazolamide follow-up

study[J/OL]. Biomed Res Int，2018，2018：6489276.

https：//doi.org/10.1155/2018/6489276.

[19] FIERSTRA J，SOBCZYK O，BATTISTICHARBONNEY

A，et al. Measuring

cerebrovascular reactivity：what stimulus to use?[J].

J Physiol，2013，591（23）：5809-5821.

[20] SILVESTRINI M，ALTAMURA C，CERQUA R，et

al. Early activation of intracranial collateral vessels

influences the outcome of spontaneous internal

carotid artery dissection[J]. Stroke，2011，42（1）：

139-143.

[21] TATEMICHI T K，CHAMORRO A，PETTY G

W，et al. Hemodynamic role of ophthalmic artery

collateral in internal carotid artery occlusion[J].

Neurology，1990，40（3）：461-464.

[22] ZAREIE H，QUAIN D A，PARSONS M，et al. The

influence of anterior cerebral artery flow diversion

measured by transcranial Doppler on acute infarct

volume and clinical outcome in anterior circulation

stroke[J]. Int J Stroke，2013，8（4）：228-234.

[23] HENDERSON R D，ELIASZIW M，FOX A J，et al.

Angiographically defined collateral circulation and

risk of stroke in patients with severe carotid artery

stenosis. North American Symptomatic Carotid

Endarterectomy Trial（NASCET）Group[J]. Stroke，

2000，31（1）：128-132.

[24] SILVESTRINI M，VERNIERI F，PASQUALETTI

P，et al. Impaired cerebral vasoreactivity and risk of

stroke in patients with asymptomatic carotid artery

stenosis[J]. JAMA，2000，283（16）：2122-2127.

[25] KIM Y S，MEYER J S，GARAMI Z，et al. Flow

diversion in transcranial Doppler ultrasound is

associated with better improvement in patients

with acute middle cerebral artery occlusion[J].

Cerebrovasc Dis，2006，21（1-2）：74-78.

[26] LENG X，LAN L，LIU L，et al. Good collateral

circulation predicts favorable outcomes in

intravenous thrombolysis：a systematic review and

meta-analysis[J]. Eur J Neurol，2016，23（12）：1738-

1749.

[27] KARGIOTIS O，SAFOURIS A，MAGOUFIS G，et

al. The role of neurosonology in the diagnosis and

management of patients with carotid artery disease：

a review[J]. J Neuroimaging，2018，28（3）：239-251.

[28] ANZOLA G P，LIMONI P，CAVRINI G.

Predictors of carotid clamping intolerance during

endarterectomy that would be wise to apply to

stenting procedures[J]. Cerebrovasc Dis，2008，26

（5）：494-501.

[29] HETZEL A，VON REUTERN G，WERNZ M G，

et al. The carotid compression test for therapeutic

occlusion of the internal carotid artery. Comparison

of angiography with transcranial Doppler

sonography[J]. Cerebrovasc Dis，2000，10（3）：194-

199.

[30] VERNIERI F，PASQUALETTI P，DIOMEDI M，et

al. Cerebral hemodynamics in patients with carotid

artery occlusion and contralateral moderate or severe

internal carotid artery stenosis[J]. J Neurosurg，2001，

94（4）：559-564.