CAJ | 학술논문

目的：探讨颈内动脉重度狭窄或闭塞的缺血性脑血管病患者Willis环侧支循环代偿及脑梗死形式。方法选择2012年3月～2014年3月天津医科大学总医院神经内科收治的颈内动脉重度狭窄或闭塞的缺血性脑血管病患者98例，其中新发脑梗死患者64例。头颅C T血管成像或磁共振血管成像显示，颅内外脑动脉狭窄情况及颅底动脉环开放形式。按颈内动脉狭窄或闭塞部位分为颅内组11例、颅外组40例及内外并存组47例，分析比较3组Willis环开放情况及脑梗死形式。结果内外并存组男性比例明显高于颅内组（91．49％ vs 54．55％，P＜0．05），糖尿病和吸烟是颅外颈内动脉重度狭窄或闭塞的独立危险因素（ P＝0．037，P＝0．042）。3组Willis环各分型发生率比较，无统计学差异（ P＞0．05）。颅外组皮质脑梗死较内外并存组增多（44．00％ v s 13．64％，P＜0．05）；内外并存组分水岭脑梗死较颅外组增多（59．09％ v s 28．00％，P＜0．05）。前交通动脉开放者颈内动脉分布区大面积脑梗死的发生较无开放者发生率低（4．00％ vs 23．08％，P＝0．048）。结论颈内动脉不同部位重度狭窄或闭塞Willis环开放形式无统计学差异，提示脑卒中发病有多种机制参与，前交通动脉开放可以降低大面积脑梗死的发生率。
목적：탐토경내동맥중도협착혹폐새적결혈성뇌혈관병환자Willis배측지순배대상급뇌경사형식。방법선택2012년3월～2014년3월천진의과대학총의원신경내과수치적경내동맥중도협착혹폐새적결혈성뇌혈관병환자98례，기중신발뇌경사환자64례。두로C T혈관성상혹자공진혈관성상현시，로내외뇌동맥협착정황급로저동맥배개방형식。안경내동맥협착혹폐새부위분위로내조11례、로외조40례급내외병존조47례，분석비교3조Willis배개방정황급뇌경사형식。결과내외병존조남성비례명현고우로내조（91．49％ vs 54．55％，P＜0．05），당뇨병화흡연시로외경내동맥중도협착혹폐새적독립위험인소（ P＝0．037，P＝0．042）。3조Willis배각분형발생솔비교，무통계학차이（ P＞0．05）。로외조피질뇌경사교내외병존조증다（44．00％ v s 13．64％，P＜0．05）；내외병존조분수령뇌경사교로외조증다（59．09％ v s 28．00％，P＜0．05）。전교통동맥개방자경내동맥분포구대면적뇌경사적발생교무개방자발생솔저（4．00％ vs 23．08％，P＝0．048）。결론경내동맥불동부위중도협착혹폐새Willis배개방형식무통계학차이，제시뇌졸중발병유다충궤제삼여，전교통동맥개방가이강저대면적뇌경사적발생솔。
Objective To study the collateral circulation compensation of Willis circle and forms of ischemic stroke in patients with ischemic cerebrovascular disease (ICD) due to internal carotid ar‐tery severe stenosis or occlusion .Methods Ninety‐eight patients with ICD due to severe internal carotid artery stenosis or occlusion admitted to our hospital from March 2012 to March 2014 were divided into intracranial ICD group (n=11) ,extracranial ICD group (n=40) ,and intracranial+extracranial ICD group (n=47) according to their CTA or MRA .The collateral branch opening of Willis circle and forms of ischemic stroke were analyzed in 3 groups .Results No significant difference in the incidence of colletral branch opening of Willis cicircle was found in 3 groups (P>0 .05) .The incidence of cortical ischemic stroke was significantly higher in extracranial ICD group than in intracranial+extracranial ICD group (44 .00% vs 13 .64% ,P=0 .023) ,that of watershed ischemic stroke was significantly higher in intracranial + extracranial ICD group than in extracra‐nial ICD group (59 .09% vs 28 .00% ,P=0 .031) ,and that of massive ischemic stroke was signifi‐cantly lower in patients with their anterior communicating artery opened than in those with their anterior communicating artery not opened (4 .00% vs 23 .08% ,P=0 .048) .Conclusion No signif‐icant difference is found in the opening forms of Willis cicircle ,w hich suggests that a variety of mechanisms are involved in the occurrence of ischemic stroke .However ,the opening of anterior communicating artery can reduce the incidence of massive ischemic stroke .