初级侧支循环对脑血流自动调节功能的影响
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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 1 A: with bilateral PCoAs; and group 1 B: without bilateral PCoAs), or isolated unilateral internal carotid artery severe stenosis/occlusion(group 2 A: without ACoA and with PCoA; group 2 B: with ACoA and without PCoAs; and group 2 C: 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 group1, and 30 patients in the group 2. There were no signi?cant differences in gender, age, and mean blood pressure between group 1 A and group 1 B, and among group 2 A, group 2 B, and group 2 C.In group 1, the PCA phase difference values(autoregulatory parameter) were signi?cantly 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.
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 1 A: with bilateral PCoAs; and group 1 B: without bilateral PCoAs), or isolated unilateral internal carotid artery severe stenosis/occlusion(group 2 A: without ACoA and with PCoA; group 2 B: with ACoA and without PCoAs; and group 2 C: 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 group1, and 30 patients in the group 2. There were no signi?cant differences in gender, age, and mean blood pressure between group 1 A and group 1 B, and among group 2 A, group 2 B, and group 2 C.In group 1, the PCA phase difference values(autoregulatory parameter) were signi?cantly 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.
引文
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[16]REINHARD M,ROTH M,MüLLER T,et al.Effect of carotid endarterectomy or stenting on impairment of dynamic cerebral autoregulation[J].Stroke,2004,35(6):1381-1387.
[17]ZHANG R,ZUCKERMAN J H,GILLER C A,et al.Transfer function analysis of dynamic cerebral autoregulation in humans[J].Am J Physiol,1998,274(1 Pt 2):H233-H241.
[18]MOORE S M,MOORHEAD K T,CHASE J G,et al.One-dimensional and three-dimensional models of cerebrovascular flow[J].J Biomech Eng,2005,127(3):440-449.
[19]GüKSU Eü,KOC P,KüüüKSEYMEN E,et al.The association of the circle of willis anomaly and risk of stroke in patients with carotid artery disease[J].Arq Neuropsiquiatr,2017,75(7):429-432.
[20]VAN SEETERS T,HENDRIKSE J,BIESSELS G J,et al.Completeness of the circle of willis and risk of ischemic stroke in patients without cerebrovascular disease[J].Neuroradiology,2015,57(12):1247-1251.(收稿日期:2018-11-15)
[2]LIN W,MA X,DENG D,et al.Hemodynamics in the circle of willis with internal carotid artery stenosis under cervical rotatory manipulation:a finite element analysis[J/OL].Med Sci Monit,2015,21:1820-1826.https://doi.org/10.12659/MSM.892822.
[3]VAN EVERDINGEN K J,VISSER G H,KLIJNC J,et al.Role of collateral flow on cerebral hemodynamics in patients with unilateral internal carotid artery occlusion[J].Ann Neurol,1998,44(2):167-176.
[4]REN Y,CHEN Q,LI Z Y.A 3D numerical study of the collateral capacity of the circle of willis with anatomical variation in the posterior circulation[J/OL].Biomed Eng Online,2015,14(Suppl 1):S11.https://doi.org/10.1186/1475-925X-14-S1-S11.
[5]FABBRI D,LONG Q,DAS S,et al.Computational modelling of emboli travel trajectories in cerebral arteries:influence of microembolic particle size and density[J].Biomech Model Mechanobiol,2014,13(2):289-302.
[6]MA H,GUO Z N,LIU J,et al.Temporal course of dynamic cerebral autoregulation in patients with intracerebral hemorrhage[J].Stroke,2016,47(3):674-681.
[7]GUO Z N,LIU J,XING Y,et al.Dynamic cerebral autoregulation is heterogeneous in different subtypes of acute ischemic stroke[J/OL].PLoS One,2014,9(3):e93213.https://doi.org/10.1371/journal.pone.0093213.
[8]CLAASSEN J A,ZHANG R.Cerebral autoregulation in Alzheimer's disease[J].J Cereb Blood Flow Metab,2011,31(7):1572-1577.
[9]GUO Z N,XING Y,LIU J,et al.Compromised dynamic cerebral autoregulation in patients with a right-to-left shunt:A potential mechanism of migraine and cryptogenic stroke[J/OL].PLoS One,2014,9(8):e104849.https://doi.org/10.1371/journal.pone.0104849.
[10]REINHARD M,MULLER T,GUSCHLBAUER B,et al.Dynamic cerebral autoregulation and collateral flow patterns in patients with severe carotid stenosis or occlusion[J].Ultrasound Med Biol,2003,29(8):1105-1113.
[11]LONG Q,LUPPI L,KüNIG C S,et al.Study of the collateral capacity of the circle of willis of patients with severe carotid artery stenosis by3Dcomputational modeling[J].J Biomech,2008,41(12):2735-2742.
[12]REINHARD M,MüLLER T,ROTH M,et al.Bilateral severe carotid artery stenosis or occlusioncerebral autoregulation dynamics and collateral flow patterns[J].Acta Neurochir(Wien),2003,145(12):1053-1059.
[13]GUO Z N,XING Y,WANG S,et al.Characteristics,of dynamic cerebral autoregulation in cerebral small vessel disease:diffuse and sustained[J/OL].Sci Rep,2015,5:15269.https://doi.org/10.1038/srep15269.
[14]CLAASSEN J A,MEEL-VAN DEN ABEELEN A S,SIMPSON D M,et al.Transfer function analysis of dynamic cerebral autoregulation:a white paper from the international cerebral autoregulation research network[J].J Cereb Blood Flow Metab,2016,36(4):665-680.
[15]REINHARD M,MüLLER T,GUSCHLBAUERB,et al.Transfer function analysis for clinical evaluation of dynamic cerebral autoregulation--a comparison between spontaneous and respiratoryinduced oscillations[J].Physiol Meas,2003,24(1):27-43.
[16]REINHARD M,ROTH M,MüLLER T,et al.Effect of carotid endarterectomy or stenting on impairment of dynamic cerebral autoregulation[J].Stroke,2004,35(6):1381-1387.
[17]ZHANG R,ZUCKERMAN J H,GILLER C A,et al.Transfer function analysis of dynamic cerebral autoregulation in humans[J].Am J Physiol,1998,274(1 Pt 2):H233-H241.
[18]MOORE S M,MOORHEAD K T,CHASE J G,et al.One-dimensional and three-dimensional models of cerebrovascular flow[J].J Biomech Eng,2005,127(3):440-449.
[19]GüKSU Eü,KOC P,KüüüKSEYMEN E,et al.The association of the circle of willis anomaly and risk of stroke in patients with carotid artery disease[J].Arq Neuropsiquiatr,2017,75(7):429-432.
[20]VAN SEETERS T,HENDRIKSE J,BIESSELS G J,et al.Completeness of the circle of willis and risk of ischemic stroke in patients without cerebrovascular disease[J].Neuroradiology,2015,57(12):1247-1251.(收稿日期:2018-11-15)