Raju T N, Kim S Y, Meller J L, Srinivasan G, Ghai V, Reyes H
Department of Pediatrics, University of Illinois College of Medicine, Chicago.
Pediatrics. 1989 Mar;83(3):343-7.
The velocity and direction of blood flow in the circle of Willis arteries were measured in three infants who underwent right common carotid artery ligation for extracorporeal membrane oxygenation treatment. Within 15 minutes of common carotid artery ligation, blood flow was detected in one infant's right middle cerebral artery; however, the velocity was reduced to 50% of the preextracorporeal membrane oxygenation level. The velocity remained 50% to 70% lower than normal during the 88 hours of extracorporeal membrane oxygenation therapy. In the other two infants, the velocity changes were less severe. By 2 to 10 weeks after weaning from extracorporeal membrane oxygenation, the velocities in the left cerebral arteries were increased to 116% to 217% of the corresponding right cerebral vessels. Following common carotid artery ligation, a retrograde direction of flow was noted in the first (A1) segment of the right anterior cerebral artery and in the right posterior communicating artery, whereas the direction of flow was normal in the corresponding vessels on the left. After common carotid artery ligation, the vertebrobasilar and the contralateral internal carotid systems appear to be the main sources of reperfusion of the right cerebral hemisphere via the circle of Willis. Furthermore, because of the known variants of the circle anatomy, a noninvasive pulsed Doppler method could be used to evaluate the flow patterns in the circle of Willis arteries, both before and after common carotid artery ligation for extracorporeal membrane oxygenation.
对三名接受右颈总动脉结扎以进行体外膜肺氧合治疗的婴儿，测量了 Willis 环动脉内的血流速度和方向。在颈总动脉结扎后 15 分钟内，在一名婴儿的右大脑中动脉检测到血流；然而，速度降至体外膜肺氧合前水平的 50%。在体外膜肺氧合治疗的 88 小时内，速度仍比正常水平低 50%至 70%。在另外两名婴儿中，速度变化不那么严重。在从体外膜肺氧合撤机后 2 至 10 周，左脑动脉的速度增加到相应右脑血管的 116%至 217%。在颈总动脉结扎后，在右大脑前动脉的第一（A1）段和右后交通动脉中观察到血流逆行，而左侧相应血管中的血流方向正常。颈总动脉结扎后，椎基底动脉和对侧颈内动脉系统似乎是通过 Willis 环对右大脑半球进行再灌注的主要来源。此外，由于 Willis 环解剖结构的已知变异，一种非侵入性脉冲多普勒方法可用于评估在进行体外膜肺氧合的颈总动脉结扎前后 Willis 环动脉中的血流模式。
