3D时间飞跃磁共振血管造影术显示的 Willis 环形态与颈动脉内膜切除术期间颈内动脉血管夹闭时短暂性缺血之间的关系。
Relationship between circle of Willis morphology on 3D time-of-flight MR angiograms and transient ischemia during vascular clamping of the internal carotid artery during carotid endarterectomy.
作者信息
Lee Jeong Hyun, Choi Choong Gon, Kim Do Kyun, Kim Geun Eun, Lee Ho Kyu, Suh Dae Chul
机构信息
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
出版信息
AJNR Am J Neuroradiol. 2004 Apr;25(4):558-64.
BACKGROUND AND PURPOSE
A potential source of complication at carotid endarterectomy (CEA) is cerebral ischemia caused by hypoperfusion during clamping of the carotid artery. Configuration of primary collateral pathways may be a major risk factor for development of transient cerebral ischemia during clamping. We investigated whether circle of Willis morphology on 3D time-of-flight (TOF) MR angiograms can reliably predict transient ischemia during vascular clamping of the internal carotid artery (ICA) in patients undergoing CEA.
METHODS
Three-dimensional TOF MR angiography and CEA were performed in 117 patients. Patients had unilateral stenosis (n = 86), unilateral stenosis with contralateral occlusion (n = 21), or bilateral severe stenosis (n = 10) of the ICA. Circle of Willis morphology on preoperative 3D TOF MR angiograms was analyzed and correlated with intraoperative history of ischemia during vascular clamping of the ICA.
RESULTS
Patients with unilateral stenosis or bilateral severe stenosis experienced transient ischemia during clamping of ICA at a low rate (11 [11%] of 96). In these groups, we found no specific circle of Willis patterns associated with development of intraoperative ischemia. However, patients with contralateral ICA occlusion experienced ischemia frequently during clamping of the ICA (12 [57%] of 21). In this group, incompleteness of the circle of Willis was significantly related to the risk of intraoperative ischemia (P =.005).
CONCLUSION
In patients without contralateral ICA occlusion, circle of Willis morphology on 3D TOF MR angiograms cannot predict the development of intraoperative ischemia. However, in patients with contralateral ICA occlusion, incompleteness of the posterior part of the circle of Willis is a significant risk factor for development of ischemia during vascular clamping of the ICA.
背景与目的
颈动脉内膜切除术（CEA）潜在的并发症来源是颈动脉夹闭期间因灌注不足导致的脑缺血。主要侧支循环通路的形态可能是夹闭期间发生短暂性脑缺血的主要危险因素。我们研究了在接受CEA的患者中，三维时间飞跃（TOF）磁共振血管造影（MRA）上的Willis环形态是否能可靠地预测颈内动脉（ICA）血管夹闭期间的短暂性缺血。
方法
对117例患者进行了三维TOF MRA和CEA。患者存在ICA单侧狭窄（n = 86）、单侧狭窄伴对侧闭塞（n = 21）或双侧严重狭窄（n = 10）。分析术前三维TOF MRA上的Willis环形态，并将其与ICA血管夹闭期间的术中缺血史进行关联。
结果
单侧狭窄或双侧严重狭窄的患者在ICA夹闭期间发生短暂性缺血的发生率较低（96例中的11例[11%]）。在这些组中，我们未发现与术中缺血发生相关的特定Willis环模式。然而，对侧ICA闭塞的患者在ICA夹闭期间频繁发生缺血（21例中的12例[57%]）。在该组中，Willis环不完整与术中缺血风险显著相关（P = 0.005）。
结论
在没有对侧ICA闭塞的患者中，三维TOF MRA上的Willis环形态不能预测术中缺血的发生。然而，在对侧ICA闭塞的患者中，Willis环后部不完整是ICA血管夹闭期间发生缺血的重要危险因素。
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