经颅多普勒超声评估颈内动脉闭塞患者的侧支血流：与脑血管造影的相关性

Transcranial Doppler ultrasound in the evaluation of collateral blood flow in patients with internal carotid artery occlusion: correlation with cerebral angiography.

作者信息

Müller M, Hermes M, Brückmann H, Schimrigk K

机构信息

Department of Neurology, Saarland University Hospital, Homburg/Saar, Germany.

出版信息

AJNR Am J Neuroradiol. 1995 Jan;16(1):195-202.

PMID:7900593

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8337692/

Abstract

PURPOSE

To determine the accuracy of transcranial Doppler (TCD) ultrasound for evaluation of collateral supply through the circle of Willis in patients with internal carotid artery (ICA) occlusion.

METHODS

The evaluation of the collateral pathways through the circle of Willis with TCD ultrasound and with cerebral angiography was compared in 40 patients (30 men, 10 women; mean age, 55 +/- 9 years) in a total of 44 ICA occlusions of which 43 had a suitable ipsilateral temporal bone window for TCD examination.

RESULTS

By TCD, a patent anterior communicating artery is indicated by a reversal blood flow in the A1-segment of the anterior cerebral artery or by a prompt fall of blood velocity in the middle cerebral artery after compression of the nonoccluded contralateral carotid artery. In 42 of 43 instances of ICA occlusion, TCD and angiography agreed in the evaluation of a present or absent anterior communicating artery collateral supply. TCD's sensitivity was 95%, its specificity 100%. A collateral supply through the basilar artery was assumed with TCD when there was: (a) a basilar artery blood velocity of more than 70 cm/s; (b) a marked increase of basilar artery blood velocity after compression of the nonoccluded carotid artery; (c) an evident side-to-side asymmetry of the blood velocity of the posterior cerebral arteries with high blood velocity ipsilateral to the ICA occlusion. For evaluating the collateralization via the basilar artery, TCD and angiography agreed in 37 of 40 ICA occlusions. TCD's sensitivity was 87%, its specificity 95%.

CONCLUSIONS

TCD is a reliable tool for the evaluation of the collateral supply in patients with ICA occlusions.

摘要

目的

确定经颅多普勒（TCD）超声评估颈内动脉（ICA）闭塞患者通过 Willis 环的侧支供血的准确性。

方法

对 40 例患者（30 例男性，10 例女性；平均年龄 55±9 岁）共 44 处 ICA 闭塞进行研究，比较 TCD 超声和脑血管造影对通过 Willis 环的侧支通路的评估，其中 43 处有适合 TCD 检查的同侧颞骨透声窗。

结果

通过 TCD，大脑前动脉 A1 段血流逆转或压迫未闭塞的对侧颈动脉后大脑中动脉血流速度迅速下降提示前交通动脉通畅。在 43 例 ICA 闭塞病例中的 42 例，TCD 和血管造影在评估前交通动脉侧支供血是否存在方面结果一致。TCD 的敏感性为 95%，特异性为 100%。当出现以下情况时，TCD 推测存在通过基底动脉的侧支供血：（a）基底动脉血流速度超过 70 cm/s；（b）压迫未闭塞的颈动脉后基底动脉血流速度显著增加；（c）大脑后动脉血流速度明显的左右不对称，ICA 闭塞同侧血流速度高。对于评估通过基底动脉的侧支循环，在 40 例 ICA 闭塞病例中的 37 例，TCD 和血管造影结果一致。TCD 的敏感性为 87%，特异性为 95%。