CAJ | 학술논문

目的观察缺血性卒中患者的责任病变血管及其侧支循环代偿方式,探讨脑动脉闭塞或严重狭窄时侧支循环的代偿作用与牛津郡社区卒中项目(OCSP)临床症状分型之间的关系.方法对211例缺血性卒中患者采用OCSP分型(完全型前循环梗死36例,部分前循环梗死94例,后循环梗死31例,腔隙性梗死50例),进行数字减影全脑血管造影检查,判定梗死的责任血管、侧支循环是否建立及代偿方式.结果检出有病变血管的患者198例,共累及病变血管206支,责任血管为颈内动脉98条、大脑中动脉54条、椎动脉27条、颈总动脉6条、基底动脉5条、锁骨下动脉4条、大脑前动脉及大脑后动脉各2条;经Willis环代偿98例,软脑膜支吻合115例,颅外代偿46例.结论脑动脉病变最多位于颈内动脉、大脑中动脉,其次位于椎动脉,前循环病变较后循环病变具有更高的梗死发生率;侧支循环代偿以Willis环最充分,软脑膜支吻合最常见;脑梗死的临床分型受病变血管与侧支循环代偿的综合影响.
목적 관찰결혈성졸중환자적책임병변혈관급기측지순배대상방식,탐토뇌동맥폐새혹엄중협착시측지순배적대상작용여우진군사구졸중항목(OCSP)림상증상분형지간적관계.방법대211례결혈성졸중환자채용OCSP분형(완전형전순배경사36례,부분전순배경사94례,후순배경사31례,강극성경사50례),진행수자감영전뇌혈관조영검사,판정경사적책임혈관、측지순배시부건립급대상방식.결과 검출유병변혈관적환자198례,공루급병변혈관206지,책임혈관위경내동맥98조、대뇌중동맥54조、추동맥27조、경총동맥6조、기저동맥5조、쇄골하동맥4조、대뇌전동맥급대뇌후동맥각2조;경Willis배대상98례,연뇌막지문합115례,로외대상46례.결론뇌동맥병변최다위우경내동맥、대뇌중동맥,기차위우추동맥,전순배병변교후순배병변구유경고적경사발생솔;측지순배대상이Willis배최충분,연뇌막지문합최상견;뇌경사적림상분형수병변혈관여측지순배대상적종합영향.
Objective To observe the compensations of diseased arteries and their collateral circulation in patients with ischemic stroke and explore the relation between compensation of collateral circulation and classification of clinical symptoms (Oxfordshire Community Stroke Project [OCSP] classification) in total or severe infarction cases. Methods Based on OCSP classification, we performed digital subtraction angiography (DSA) on 211 patients with cerebral infarction to identify the existence of diseased arteries and their collateral circulations, and the appearance of their compensations. Results one hundred and ninety-eight patients were identified as having diseased arteries with a total number of 206, including 98 internal carotid arteries (ICAs), 54 middle cerebral arteries (MCAs), 27 vertebral arteries (VAs), 6 common carotid arteries (CCAs), 5 basilar arteries (BAs), 4 subclavian arteries (SCAs) and 4 other arteries. Leptomeningeal anastomose compensated 115 arteries, Willis circle compensated 98, and the other 46 were compensated by external-cranium arteries. Conclusions ICAs and MCAs are the firstly involved arteries in patients with cerebral infarction, followed by VAs. Anterior circulation arteries lesions arouse more cerebral infarctions than posterior circulation arteries lesions do. Compensation by Willis circle is the most sufficient type in ischemic stroke cases;while compensation by Leptomeningeal anastomose is the most frequent one. The classification of cerebral infarction is mainly affected by the compensations of diseased arteries and collateral circulation.