Chuang Yu-Ming, Lin Ching-Po, Wong Ho-Fai, Chang Yeu-Jhy, Chang Chien-Hung, Chang Ting-Yu, Wu Tai-Cheng, Wu Hsiu-Chuan, Lee Tsong-Hai
Department of Neurology, Lo-Sheng Sanatorium, Taoyuan, Taiwan.
Cerebrovasc Dis. 2009;27(6):572-8. doi: 10.1159/000214221. Epub 2009 Apr 24.
The purpose of the present study was to assess whether the direction of flow via the circle of Willis (CoW) changed after stenting for severe internal carotid artery (ICA) stenosis.
65 patients (38 men, mean age 63.2 +/- 8.4 years, range 44-82) with a symptomatic ICA occlusion were investigated. Magnetic resonance angiography was performed prior to and 1 week after carotid artery stenting (CAS). The pattern in the CoW was assessed.
One third of the subjects (35.38%) had a significantly altered flow pattern in the CoW after unilateral CAS, including blocked ipsilateral A1 segment collateral (n = 4), blocked contralateral A1 segment collateral (n = 5), blocked ipsilateral posterior communicating artery (PCoA) segment collateral (n = 4), blocked ipsilateral A1 segment and P1 segment collateral (n = 1), opening of ipsilateral A1 segment collateral (n = 5), opening of ipsilateral PCoA segment collateral (n = 3) and opening of ipsilateral P1 segment collateral (n = 1).
CoW segmental hypoplasia is not a static feature. Willisian collateralization with recruitment of the CoW segment (A1, P1 and PCoA) may be blocked after CAS. CAS also leads to the opening of new willisian collateralization, either for relief of reperfusion pressure or for other hypoperfused areas.
本研究旨在评估重度颈内动脉（ICA）狭窄支架置入术后经 Willis 环（CoW）的血流方向是否发生改变。
对 65 例有症状的 ICA 闭塞患者（38 例男性，平均年龄 63.2±8.4 岁，范围 44 - 82 岁）进行了研究。在颈动脉支架置入术（CAS）前及术后 1 周进行磁共振血管造影。评估 CoW 的血流模式。
三分之一的受试者（35.38%）在单侧 CAS 后 CoW 的血流模式有显著改变，包括同侧 A1 段侧支阻塞（n = 4）、对侧 A1 段侧支阻塞（n = 5）、同侧后交通动脉（PCoA）段侧支阻塞（n = 4）、同侧 A1 段和 P1 段侧支阻塞（n = 1）、同侧 A1 段侧支开放（n = 5）、同侧 PCoA 段侧支开放（n = 3）以及同侧 P1 段侧支开放（n = 1）。
CoW 节段发育不全并非静态特征。CAS 后，CoW 节段（A1、P1 和 PCoA）的 Willis 侧支循环可能会被阻断。CAS 还会导致新的 Willis 侧支循环开放，要么是为了缓解再灌注压力，要么是为了其他灌注不足的区域。
