研究大脑中动脉 Willis 环结构与双侧颈内动脉闭塞侧支循环的相关性。
Study on the correlation between the circle of Willis structure and collateral circulation in bilateral carotid artery occlusion.
机构信息
Department of Neurology, The Second Affiliated Hospital of Qiqihar Medical university, No.37 West Zhonghua Road, Qiqihar, 161006, Heilongjiang, China.
Department of Nucleus Radiation-related Injury Treatment, PLA Rocket Force Characteristic Medical Center, No.16 Xinjiekouwai Street, Xicheng District, Beijing, 100088, China.
出版信息
Neurol Sci. 2021 Dec;42(12):5335-5342. doi: 10.1007/s10072-021-05265-4. Epub 2021 Apr 23.
BACKGROUND AND PURPOSE
Bilateral carotid artery occlusion (CAO) is a rare condition and the collateral circulation is more complicated than in unilateral CAO. The circle of Willis (CoW) is the most important collateral circulation compensation pathway in CAO. However, the specific role of CoW in the collateral circulation compensation pathway of CAO has not been fully elucidated. The purpose of this study is to investigate the role of CoW in the collateral circulation compensation pathway of CAO.
MATERIALS AND METHODS
Clinical, imaging, and hemodynamic data of 30 patients with bilateral CAO were collected to analyze the collateral blood flow compensation pathway and its characteristics, and to examine the correlation between the structure of the CoW and the collateral circulation of bilateral CAO.
RESULTS
This paper summarized 30 patients with bilateral CAO. There were 0 cases of the CoW complete type, 18 cases of the partially complete type (60%), and 12 cases of the incomplete type (40%). For the partially complete type cases, there were 14 complete anterior circulation cases (46.7%). The collateral circulation collateral circulation pathway included 14 cases with anterior communicating artery(ACoA), 7 cases with posterior cerebral artery (PCA)-middle cerebral artery (MCA) leptomeningeal anastomosis (LMA), 5 cases with ophthalmic artery(OA), 3 cases with lateral posterior communicating artery(PCoA), 1 case with internal carotid artery (ICA) stealing, 1 case with new Moyamoya vessels, and 4 cases of other types. There were four cases (13.3%) with complete posterior circulation, including four cases with bilateral PCoA, three cases with PCA-MCA LMA, and two cases with OA. There were 12 cases (40%) with incomplete CoW, including 8 cases with PCA-MCA LMA, 3 cases with lateral PCoA, 1 case with anterior cerebral artery (ACA)-MCA LMA, 4 cases with OA, and 1 other case.
CONCLUSION
The collateral circulation pathway differs among patients with different CoW structure types. When the CoW is partially complete, it mainly provides blood flow compensation to the ischemic area through primary collateral circulation. When the CoW is incomplete, it mainly provides blood flow compensation to the ischemic area through secondary collateral circulation.
背景与目的
双侧颈内动脉闭塞（CAO）较为少见，其侧支循环较单侧 CAO 更为复杂。Willis 环（CoW）是 CAO 中最重要的侧支循环代偿途径。然而，CoW 在 CAO 侧支循环代偿途径中的具体作用尚未完全阐明。本研究旨在探讨 CoW 在 CAO 侧支循环代偿途径中的作用。
材料与方法
收集 30 例双侧 CAO 患者的临床、影像和血流动力学资料，分析其侧支血流代偿途径及其特点，并探讨 CoW 结构与双侧 CAO 侧支循环的相关性。
结果
本文总结了 30 例双侧 CAO 患者。其中 CoW 完全型 0 例，部分完全型 18 例（60%），不完全型 12 例（40%）。对于部分完全型病例，完全前循环 14 例（46.7%）。侧支循环代偿途径包括前交通动脉（ACoA）14 例、大脑后动脉（PCA）-大脑中动脉（MCA）软脑膜吻合（LMA）7 例、眼动脉（OA）5 例、外侧后交通动脉（PCoA）3 例、颈内动脉虹吸段盗血 1 例、新生烟雾病血管 1 例、其他类型 4 例。完全后循环 4 例（13.3%），双侧 PCoA 4 例，PCA-MCA LMA 3 例，OA 2 例。不完全 CoW 12 例（40%），其中 PCA-MCA LMA 8 例，外侧 PCoA 3 例，ACA-MCA LMA 1 例，OA 4 例，其他 1 例。
结论
不同 CoW 结构类型患者的侧支循环途径不同。当 CoW 部分完全时，主要通过初级侧支循环为缺血区提供血流代偿；当 CoW 不完全时，主要通过次级侧支循环为缺血区提供血流代偿。
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