Czabanka Marcus, Acker Gueliz, Jussen Daniel, Finger Tobias, Pena-Tapia Pablo, Schubert Gerrit A, Scharf Johann, Martus Peter, Schmiedek Peter, Vajkoczy Peter
Department of Neurosurgery, Universitätsmedizin Charite, Berlin, Germany,
Acta Neurochir (Wien). 2014 Nov;156(11):2051-8; discussion 2058. doi: 10.1007/s00701-014-2227-1. Epub 2014 Sep 25.
Moyamoya disease and atherosclerotic cerebrovascular occlusive disease lead to hemodynamic impairment of cerebral blood flow. One major differentiation between both disease entities lies in the collateralization pathways. The clinical implications of the collateralization pathways for the development of hemodynamic ischemia remain unknown. The aim was to characterize collateralization and ischemia patterns in patients with chronic hemodynamic compromise.
Hemodynamic compromise was verified using acetazolamide-stimulated xenon-CT or SPECT in 54 patients [30 moyamoya and 24 atherosclerotic cerebrovascular disease (ACVD)]. All patients received MRI to differentiate hemodynamic ischemia into anterior/posterior cortical border zone infarction (CBI), inferior border zone infarction (IBI) or territorial infarction (TI). Digital subtraction angiography was applied to evaluate collateralization. Collateralization was compared and correlated with the localization of ischemia and number of vascular territories with impaired cerebrovascular reserve capacity (CVRC).
MM patients showed collateralization significantly more often via pericallosal anastomosis and the posterior communicating artery (flow in the anterior-posterior direction; MM: 95%/95% vs. ACVD: 23%/12%, p < 0.05). ACVD patients demonstrated collateralization via the anterior and posterior communicating arteries (flow in the posterior-anterior direction, MM: 6%/5% vs. ACVD: 62%/88%, p < 0.05). Patterns of infarction were comparable (aCBI: MM: 36% vs. ACVD: 35%; pCBI: MM: 10% vs. ACVD: 20%; IBI: MM: 35% vs. ACVD: 41%; TI: MM: 13% vs. ACVD: 18%). The number and localization of vascular territories with impaired CVRC were comparable.
Despite significant differences in collateralization, the infarct patterns and severity of CVRC impairment do not differ between MMV and ACVD patients. Cerebral collateralization does not allow reaching conclusions about the localization of cerebral ischemia or severity of impaired CVRC in chronic hemodynamic impairment.
烟雾病和动脉粥样硬化性脑血管闭塞性疾病会导致脑血流动力学受损。这两种疾病实体的一个主要区别在于侧支循环途径。侧支循环途径对血流动力学缺血发展的临床意义尚不清楚。目的是描述慢性血流动力学受损患者的侧支循环和缺血模式。
使用乙酰唑胺激发的氙CT或SPECT对54例患者[30例烟雾病和24例动脉粥样硬化性脑血管疾病（ACVD）]进行血流动力学受损的验证。所有患者均接受MRI检查，以将血流动力学缺血区分为前/后皮质边缘带梗死（CBI）、下边缘带梗死（IBI）或区域梗死（TI）。应用数字减影血管造影术评估侧支循环。比较侧支循环情况，并将其与缺血定位以及脑血管储备能力（CVRC）受损的血管区域数量进行关联分析。
烟雾病患者通过胼周吻合和后交通动脉形成侧支循环的情况明显更常见（前后向血流；烟雾病：95%/95%，而ACVD：23%/12%，p<0.05）。ACVD患者通过前交通和后交通动脉形成侧支循环（后前向血流，烟雾病：6%/5%，而ACVD：62%/88%，p<0.05）。梗死模式具有可比性（前CBI：烟雾病：36%，而ACVD：35%；后CBI：烟雾病：10%，而ACVD：20%；IBI：烟雾病：35%，而ACVD：41%；TI：烟雾病：13%，而ACVD：18%）。CVRC受损的血管区域数量和定位具有可比性。
尽管侧支循环存在显著差异，但烟雾病和ACVD患者的梗死模式及CVRC受损程度并无差异。在慢性血流动力学损害中，脑侧支循环无法用于推断脑缺血的定位或CVRC受损的严重程度。
