初级侧支循环对脑血流自动调节功能的影响

摘要

ACoA和PCoA对dCA功能的影响尚不清楚.本研究旨在探究初级侧支循环的解剖差异对dCA功能的影响.根据DSA影像特点将分为两组:孤立的BA和(或)双侧VA严重狭窄/闭塞组(组1A:双侧PCoAs存在;组1B:双侧PCoAs缺如);孤立的单侧ICA严重狭窄/闭塞(组2A:无ACoA而存在同侧PCoA;组2B:存在ACoA而无PCoAs;组2C:无ACoA和PCoA).使用传递函数法评估MCA和(或)PCA的dCA功能.在2014-2017年间接受dCA评估和DSA检查的231例非急性期缺血性卒中患者中,有51例患者符合纳入标准,其中21例患者被纳入组1,30例患者被纳入组2.组1A与1B、2A与2B及2C组患者之间在性别、年龄和平均动脉压方面均无显著差异.组1中,存在PCoAs的患者PCA相位差(自动调节参数)显著高于PCoAs缺如者.组2中,MCA相位差在有ACoA患者中显著高于无ACoA患者.本研究发现,ACoA/PCoA的开放可以代偿缺血区受损的dCA功能,这表明ACoA/PCoA在维持脑血流的稳定中发挥着重要的作用.%The influence of the anterior and posterior communicating artery (ACoA and PCoA) on dCA is largely unknown. In this study, we aimed to test whether substantial differences in collateral anatomy were associated with differences in dCA in two common types of stenosis according to DSA: either isolated basal artery and/or bilateral vertebral arteries severe stenosis/occlusion (group 1A: with bilateral PCoAs; and group 1B: without bilateral PCoAs), or isolated unilateral internal carotid artery severe stenosis/occlusion (group 2A: without ACoA and with PCoA; group 2B: with ACoA and without PCoAs; and group 2C: without both ACoA and PCoA). The dCA was calculated by transfer function analysis (a mathematical model), and was evaluated in MCA and/or PCA. Of a total of 231 non-acute phase ischemic stroke patients who received both dCA assessment and DSA in our lab between 2014 and 2017, 51 patients met inclusion criteria based on the presence or absence of ACoA or PCoA, including 21 patients in the group 1, and 30 patients in the group 2. There were no significant differences in gender, age, and mean blood pressure between group 1A and group 1B, and among group 2A, group 2B, and group 2C. In group 1, the PCA phase difference values (autoregulatory parameter) were significantly higher in the subgroup with patent PCoAs, compared to those without. In group 2, the MCA phase difference values were higher in the subgroup with patent ACoA, compared to those without. This pilot study found that the cross-flow of the ACoA/PCoA to the affected area compensates for compromised dCA in the affected area, which suggests an important role of the ACoA/PCoA in stabilizing cerebral blood flow.