van den Berg René, Wildeman Jenna J, Berkhemer Olvert A, Immink Rogier V, Marquering Henk A, Majoie Charles B L M, Verbaan Dagmar, van Bavel Ed T
Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AMC), Amsterdam, The Netherlands.
Department of Biomedical Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
Neurointervention. 2020 Nov;15(3):126-132. doi: 10.5469/neuroint.2020.00269. Epub 2020 Oct 19.
In acute middle cerebral artery (MCA) occlusion, collateral vessels provide retrograde supply to the occluded territory. We hypothesized that such collateral flow reduces perfusion of the non-occluded donor region (steal effect).
Patients with an MCA occlusion with opacification of both ipsi- and contralateral anterior cerebral arteries (ACA) on angiography prior to endovascular treatment were selected. Arteriovenous transit time (AVTT) for both ACA territories was compared for different grades of collateral supply to the MCA territory. In addition, the influence of diabetes and hypertension was analyzed. After successful revascularization, AVTT was re-assessed to determine reversibility.
Forty-one patients were analyzed. An AVTT of 8.6 seconds (standard deviation [SD] 2.4 seconds) was seen in the ACA territory of the affected hemisphere in comparison to 6.6 seconds (SD 2.1 seconds) for the contralateral side (P<0.001). A more prolonged (but not significant) AVTT was seen in cases with a higher collateral grade. No difference in AVTT was seen in patients with diabetes or hypertension. After successful MCA revascularization, AVTT delay was 7.4 seconds (SD 2.1 seconds).
A cerebral steal effect occurs in patients with an acute MCA occlusion, probably related to augmented flow to the penumbra area.
在急性大脑中动脉（MCA）闭塞时，侧支血管为闭塞区域提供逆行供血。我们推测这种侧支血流会减少未闭塞供血区域的灌注（盗血效应）。
选择在血管内治疗前血管造影显示同侧和对侧大脑前动脉（ACA）均显影的MCA闭塞患者。比较不同等级侧支供血至MCA区域时双侧ACA区域的动静脉 transit 时间（AVTT）。此外，分析糖尿病和高血压的影响。成功再灌注后，重新评估AVTT以确定其可逆性。
分析了41例患者。患侧半球ACA区域的AVTT为8.6秒（标准差[SD]2.4秒），而对侧为6.6秒（SD 2.1秒）（P<0.001）。侧支等级较高的病例中可见AVTT延长（但无显著性差异）。糖尿病或高血压患者的AVTT无差异。MCA成功再灌注后，AVTT延迟为7.4秒（SD 2.1秒）。
急性MCA闭塞患者会出现脑盗血效应，可能与向半暗带区域的血流增加有关。
