Hetzel A, von Reutern G, Wernz M G, Droste D W, Schumacher M
Department of Neurology, University Clinics of Freiburg, Germany.
Cerebrovasc Dis. 2000 May-Jun;10(3):194-9. doi: 10.1159/000016056.
The anterior communicating artery is a key collateral pathway in patients with internal carotid artery (ICA) occlusions. Diagnostic balloon or manual occlusion of the ICA is a qualified test for the collateral function of the circle of Willis. The aim of our study was to test whether transcranial Doppler sonography (TCD) with manual carotid compression is able to predict the degree of cross-over flow and tolerance of ICA occlusion.
A prospective study was performed on 88 patients suffering from neck tumors or inoperable ICA aneurysms with planned ligation or permanent balloon occlusion of the ICA. Preceding a balloon occlusion lasting 20 min we performed TCD with manual carotid compression test. Insufficient cross-over flow during transient carotid occlusion was defined angiographically as missing opacification of the middle cerebral artery (MCA) after selective injection of contrast media in the contralateral ICA, and sonographically as a decrease greater than 60% in flow velocity of the MCA ipsilateral to the carotid occlusion.
TCD and angiography could be compared in 70 of 88 patients. Angiography showed no or insufficient collateral flow in 26%. All patients (n = 10) with a decrease in MCA velocity greater than 60% on angiography showed missing or poor cross-over flow. A greater than 50% increase in the anterior cerebral artery (ACA) predicted moderate or good cross-over flow in 98%. Clinical observation revealed 11 transient neurological deficits. Eight of them showed insufficient cross-over flow angiographically and sonographically. In 2 of 11 only TCD revealed such low collateral supply. Neither technique predicted hemodynamic ischemia in only 1 of the 11.
TCD with carotid compression test is a valid method for predicting interhemispheric flow and clinically relevant hemodynamic compromise in cases of occlusion of the ICA.
前交通动脉是颈内动脉（ICA）闭塞患者的关键侧支循环途径。ICA的诊断性球囊闭塞或手法闭塞是对Willis环侧支循环功能的有效测试。我们研究的目的是测试经颅多普勒超声（TCD）联合颈动脉手法压迫能否预测交叉血流程度及ICA闭塞的耐受性。
对88例患有颈部肿瘤或无法手术的ICA动脉瘤且计划结扎或永久性球囊闭塞ICA的患者进行了一项前瞻性研究。在持续20分钟的球囊闭塞之前，我们进行了TCD联合颈动脉手法压迫试验。短暂性颈动脉闭塞期间交叉血流不足在血管造影上定义为对侧ICA选择性注射造影剂后大脑中动脉（MCA）不显影，在超声检查中定义为颈动脉闭塞同侧MCA血流速度下降超过60%。
88例患者中有70例可进行TCD与血管造影的比较。血管造影显示26%的患者侧支血流无或不足。血管造影显示MCA速度下降超过60%的所有患者（n = 10）均显示交叉血流缺失或不佳。大脑前动脉（ACA）流速增加超过50%预测98%的患者交叉血流中度或良好。临床观察发现11例短暂性神经功能缺损。其中8例在血管造影和超声检查中显示交叉血流不足。11例中有2例仅TCD显示侧支供血不足。两种技术均未预测出11例中仅1例的血流动力学缺血情况。
TCD联合颈动脉压迫试验是预测ICA闭塞时半球间血流及临床相关血流动力学损害的有效方法。
