Jatuzis D, Zachrisson H, Blomstrand C, Ekholm S, Holm J, Volkmann R
Department of Neurology, Sahlgrenska University Hospital, S-4113 45 Göteborg, Sweden.
J Clin Ultrasound. 2000 Nov-Dec;28(9):452-60. doi: 10.1002/1097-0096(200011/12)28:9<452::aid-jcu2>3.0.co;2-6.
Investigations of the posterior cerebral arteries (PCA) by transcranial Doppler sonography (TCD) may be less reliable than investigations of the anterior part of the circle of Willis. Nevertheless, a true PCA may be identified by manual compression of the proximal common carotid artery (CCA) during TCD. Therefore, we used CCA compression in clinically indicated TCD studies and assessed retrospectively its risks and prospectively its benefits for PCA evaluations.
Using the transtemporal approach, we prospectively assessed flow velocities in posteriorly located blood vessels in 180 consecutive patients before and during CCA compression. The complications of CCA compression were retrospectively reviewed in all 3,383 clinical TCD investigations performed over an 8-year period.
Decreased flow velocities during ipsilateral CCA compression occurred in 17% of patients. A PCA-like vessel with perfusion from the carotid artery or PCA supply from the carotid circulation was unmasked. Mixed distal PCA support by the posterior communicating artery and proximal PCA could not be shown by TCD. Transient cerebral symptoms occurred in less than 0.4% of the 3,383 retrospectively reviewed TCD investigations; no other adverse effects were seen.
TCD without CCA compression may lead to false identification of the PCA. Since transient cerebral symptoms during CCA compression are rare, CCA compression can be used when a clinical TCD investigation of intracranial collateral blood flow compensation is indicated or when the identification of a cerebral artery is uncertain.
经颅多普勒超声（TCD）对大脑后动脉（PCA）的检测可能不如对 Willis 环前部的检测可靠。然而，在 TCD 检查期间，通过手动压迫颈总动脉近端（CCA）可识别出真正的 PCA。因此，我们在临床指征的 TCD 研究中使用了 CCA 压迫，并回顾性评估其风险，前瞻性评估其对 PCA 评估的益处。
采用颞窗途径，我们前瞻性评估了 180 例连续患者在 CCA 压迫前后位于后方血管的血流速度。在 8 年期间进行的所有 3383 例临床 TCD 检查中，回顾性分析了 CCA 压迫的并发症。
17%的患者在同侧 CCA 压迫期间血流速度降低。发现了一条类似 PCA 的血管，其由颈动脉供血或由颈动脉循环供应 PCA。TCD 无法显示后交通动脉对远端 PCA 的混合支持以及近端 PCA。在回顾性分析的 3383 例 TCD 检查中，短暂性脑症状的发生率低于 0.4%；未观察到其他不良反应。
不进行 CCA 压迫的 TCD 可能会导致对 PCA 的错误识别。由于 CCA 压迫期间短暂性脑症状很少见，因此当临床需要对颅内侧支血流代偿进行 TCD 检查或在脑动脉识别不确定时，可使用 CCA 压迫。
