Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, PR China.
Beijing Diagnostic Center of Vascular Ultrasound, Beijing, PR China.
Vasc Med. 2023 Aug;28(4):308-314. doi: 10.1177/1358863X231171611. Epub 2023 May 30.
The effect of anterior communicating artery (ACoA) patency on the flow velocity of the extracranial carotid arteries is unclear.
A total of 285 patients with carotid artery stenosis were included between January 2019 and January 2021. All patients received unilateral carotid endarterectomy (CEA). The patients were classified into ACoA-patent (161) and ACoA-nonpatent (124) groups using digital subtraction angiography (DSA) and/or computed tomography angiography (CTA). The peak systolic velocity (PSV) and end-diastolic velocity (EDV) measured by carotid duplex ultrasonography (CDU) were compared between both groups, pre- and post-CEA.
There was no significant difference in the risk factors for cerebrovascular disease between the two groups. Within 1 week after CEA, the PSV and EDV on operative and nonoperative carotid (contralateral carotid in the same patient) arteries decreased significantly (both < 0.01). Comparison of nonoperative carotid artery pre- and post-CEA between the two groups showed that post-CEA PSV and EDV in the ACoA-patent group were significantly lower than that of pre-CEA (PSV and EDV, = 11.507 and 6.716, respectively, both < 0.001) (according to the Society of Radiologists in Ultrasound Consensus Conference [SRUCC] PSV standard). There was no significant difference in the ACoA-nonpatent group (PSV: = 1.924, = 0.057; EDV: = 1.237, = 0.218). In the nonoperative carotid artery of the ACoA-patent group, the degree of stenosis assessed by CDU was inconsistent with that of DSA/CTA (κ = 0.294), whereas that in the ACoA-nonpatent group had a high consistency (κ = 0.982). Among 161 ACoA-patent cases, 68 showed overestimated stenosis.
The patent ACoA increases PSV and EDV, causing an overestimation of carotid artery stenosis.
前交通动脉（ACoA）通畅对颅外颈动脉血流速度的影响尚不清楚。
2019 年 1 月至 2021 年 1 月期间共纳入 285 例颈动脉狭窄患者。所有患者均接受单侧颈动脉内膜切除术（CEA）。采用数字减影血管造影（DSA）和/或计算机断层血管造影（CTA）将患者分为 ACoA 通畅（161 例）和 ACoA 不通畅（124 例）两组。比较两组患者颈动脉双功能超声（CDU）术前和术后的收缩期峰值速度（PSV）和舒张末期速度（EDV）。
两组患者的脑血管病危险因素无显著差异。CEA 后 1 周内，手术侧和非手术侧颈动脉（同一位患者的对侧颈动脉）PSV 和 EDV 均显著下降（均 < 0.01）。两组患者非手术侧颈动脉 CEA 前后比较发现，ACoA 通畅组 CEA 后 PSV 和 EDV 明显低于 CEA 前（PSV 和 EDV， = 11.507 和 6.716，均 < 0.001）（根据超声放射学会共识会议 [SRUCC] PSV 标准）。ACoA 不通畅组无显著差异（PSV： = 1.924， = 0.057；EDV： = 1.237， = 0.218）。在 ACoA 通畅组的非手术侧颈动脉中，CDU 评估的狭窄程度与 DSA/CTA 不一致（κ = 0.294），而 ACoA 不通畅组的狭窄程度具有高度一致性（κ = 0.982）。在 161 例 ACoA 通畅病例中，68 例存在狭窄程度高估。
通畅的 ACoA 增加 PSV 和 EDV，导致颈动脉狭窄程度高估。
