Romero José R, Pikula Aleksandra, Nguyen Thanh N, Nien Yih Lin, Norbash Alexander, Babikian Viken L
Departments of Neurology (JRR, AP, TNN, YLN, VLB), Neurosurgery (TNN), and Radiology (AN, TNN), Boston University Medical Center and Boston University School of Medicine, Boston, Massachusetts; the Framingham Heart Study (JRR, AP), Framingham, Massachusetts; and the Boston VAMC (VLB), Boston, Massachusetts, USA.
Curr Cardiol Rev. 2009 Nov;5(4):279-88. doi: 10.2174/157340309789317887.
Carotid artery disease is common and increases the risk of stroke. However, there is wide variability on the severity of clinical manifestations of carotid disease, ranging from asymptomatic to fatal stroke. The collateral circulation has been recognized as an important aspect of cerebral circulation affecting the risk of stroke as well as other features of stroke presentation, such as stroke patterns in patients with carotid artery disease. The cerebral circulation attempts to maintain constant cerebral perfusion despite changes in systemic conditions, due to its ability to autoregulate blood flow. In case that one of the major cerebral arteries is compromised by occlusive disease, the cerebral collateral circulation plays an important role in preserving cerebral perfusion through enhanced recruitment of blood flow. With the advent of techniques that allow rapid evaluation of cerebral perfusion, the collateral circulation of the brain and its effectiveness may also be evaluated, allowing for prompt assessment of patients with acute stroke due to involvement of the carotid artery, and risk stratification of patients with carotid stenosis in chronic stages. Understanding the cerebral collateral circulation provides a basis for the future development of new diagnostic tools, risk stratification, predictive models and new therapeutic modalities. In the present review we discuss basic aspects of the cerebral collateral circulation, diagnostic methods to assess collateral circulation, and implications in occlusive carotid artery disease.
颈动脉疾病很常见，会增加中风风险。然而，颈动脉疾病临床表现的严重程度差异很大，从无症状到致命性中风不等。侧支循环已被认为是脑循环的一个重要方面，它会影响中风风险以及中风表现的其他特征，比如颈动脉疾病患者的中风类型。尽管全身状况发生变化，但由于脑循环具有自动调节血流的能力，它会试图维持恒定的脑灌注。如果一条主要脑动脉因闭塞性疾病而受损，脑侧支循环在通过增加血流募集来维持脑灌注方面发挥着重要作用。随着能够快速评估脑灌注的技术的出现，脑侧支循环及其有效性也可以得到评估，这有助于对因颈动脉受累而发生急性中风的患者进行及时评估，以及对慢性期颈动脉狭窄患者进行风险分层。了解脑侧支循环为未来开发新的诊断工具、风险分层、预测模型和新的治疗方法提供了基础。在本综述中，我们讨论了脑侧支循环的基本方面、评估侧支循环的诊断方法以及它们在颈动脉闭塞性疾病中的意义。
