Klotzsch C, Popescu O, Berlit P
Department of Neurology, Alfried-Krupp Hospital, Essen, Germany.
Stroke. 1996 Mar;27(3):486-9. doi: 10.1161/01.str.27.3.486.
The aim of this study was to investigate flow velocity and flow direction in the posterior communicating artery (PcomA) by means of transcranial color-coded duplex sonography (TCCD) and to compare the results with angiographic findings.
Thirty patients with unilateral occlusion of the internal carotid artery (ICA) due to atherosclerosis (n=15) or balloon occlusion (n=15) and 50 normal subjects were included. The circle of Willis was insonated through the temporal bone window. In 24 patients with unilateral ICA occlusion, angiograms were available and were compared with the results of TCCD.
The PcomA could be detected unilaterally in 70% of normal subjects and bilaterally in 30%. A retrograde flow direction in the PcomA from the posterior cerebral artery to the ICA was found in 75% of the normal control subjects. The mean peak flow velocity in normal PcomAs was 36 +/- 15 cm/s (+/- SD). No significant differences in flow velocity were found between unilaterally and bilaterally detectable PcomAs or between retrograde and orthograde PcomAs. In patients with unilateral ICA occlusion we observed ipsilaterally a retrograde flow direction, with an elevation of flow velocity (64 +/- 10 cm(s) compared with the contralateral side (27 +/- 14 cm/s; P<.001).
TCCD appears to be a valuable method to determine flow velocity and flow direction not only in the large intracranial vessels but also in the smaller communicating arteries. In the future this method could be useful for the planning of ICA balloon occlusions and in deciding whether to perform extracranial/intracranial bypass surgery. It could furthermore show intracranial collaterals in patients with cerebrovascular disease and help to estimate the risk of watershed infarctions in patients with asymptomatic high-grade ICA stenosis and in patients undergoing carotid endarterectomy.
本研究旨在通过经颅彩色编码双功能超声（TCCD）研究后交通动脉（PcomA）的血流速度和血流方向，并将结果与血管造影结果进行比较。
纳入30例因动脉粥样硬化（n = 15）或球囊闭塞（n = 15）导致单侧颈内动脉（ICA）闭塞的患者以及50例正常受试者。通过颞骨窗对Willis环进行超声检查。24例单侧ICA闭塞患者有血管造影图像，并与TCCD结果进行比较。
70%的正常受试者可单侧检测到PcomA，30%可双侧检测到。75%的正常对照受试者中发现PcomA存在从大脑后动脉至ICA的逆向血流方向。正常PcomA的平均峰值血流速度为36±15 cm/s（±标准差）。单侧和双侧可检测到的PcomA之间或逆向和正向PcomA之间的血流速度无显著差异。在单侧ICA闭塞患者中，我们观察到同侧血流方向为逆向，血流速度升高（64±10 cm/s），而对侧为（27±14 cm/s；P<0.001）。
TCCD似乎是一种不仅可用于确定颅内大血管，还可用于确定较小交通动脉血流速度和血流方向的有价值方法。未来，该方法可能有助于ICA球囊闭塞的规划以及决定是否进行颅外/颅内搭桥手术。此外，它还可以显示脑血管疾病患者的颅内侧支循环，并有助于评估无症状重度ICA狭窄患者和接受颈动脉内膜切除术患者发生分水岭梗死的风险。
