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目的探讨重度颅外颈内动脉狭窄(EICAS)血流动力学改变与不同类型脑梗死间的关系。方法重度EICAS病人128例,根据有无脑梗死及短暂性脑缺血发作(TIA),分为症状性EICAS组与无症状性EICAS组;病人于发病1周内行颅脑MRI检查,根据梗死灶形态,将病人分为区域型脑梗死(Ⅰ型)组、皮质下梗死(Ⅱ型)组、弥散性梗死(Ⅲ型)组及分水岭梗死(Ⅳ型)组4组,用TCD评价各组狭窄后脑血流动力学改变,包括大脑中动脉收缩期峰值血流速度(PSVMCA)及侧支循环开放情况,评价狭窄后脑血流动力学改变与不同类型脑梗死间的关系。结果 128例重度EICAS病人中,症状性EICAS组侧支循环开放情况与无症状性EICAS组比较差异有显著性(P=0.004)。不同类型脑梗死侧支循环开放比较差异无显著性(P>0.05)。无症状性EICAS组病变侧PSVMCA中位数与症状性EICAS组相比,差异有显著性(W=905,P<0.05);不同类型脑梗死患侧PSVMCA中位数显著不同,Ⅲ型梗死组PSVMCA水平高于其他组,Ⅱ型梗死组PSVMCA水平低于其他组,差异有显著意义(H=10.67,P<0.05)。结论重度EICAS后侧支循环开放与脑梗死类型无关,狭窄后PSVMCA与脑梗死类型有关。
Objective To investigate the relationship between hemodynamic changes of severe extracranial internal carotid artery stenosis (EICAS) and different types of cerebral infarction. Methods A total of 128 patients with severe EICAS were divided into two groups according to the presence or absence of cerebral infarction and transient ischemic attack (TIA): EICAS group and asymptomatic EICAS group. Patients underwent cerebral MRI examination within 1 week of onset. According to infarction The patients were divided into 4 groups: regional cerebral infarction (type Ⅰ), subcortical infarction (type Ⅱ), diffuse infarction (Ⅲ) and watershed infarction (type Ⅳ) Cerebral hemodynamic changes, including peak systolic velocity of the middle cerebral artery (PSVMCA) and collateral circulation, were evaluated to evaluate the relationship between cerebral hemodynamic changes after stenosis and different types of cerebral infarction. Results Among 128 patients with severe EICAS, the collateral circulation in symptomatic EICAS group was significantly different from that in asymptomatic EICAS group (P = 0.004). There was no significant difference in the collateral circulation between different types of cerebral infarction (P> 0.05). The median PSVMCA in the asymptomatic EICAS group was significantly higher than that in the symptomatic EICAS group (W = 905, P <0.05). The median PSVMCA was significantly different in different types of cerebral infarction The level of PSVMCA was higher in patients with type Ⅱ infarction than those in other groups. The difference was significant (H = 10.67, P <0.05). Conclusion The open circulation of collateral circulation after severe EICAS has nothing to do with the type of cerebral infarction. PSVMCA is related to the type of cerebral infarction after stenosis.