伴同侧颈内动脉系统狭窄/闭塞脑梗死患者影像学病灶模式及侧枝代偿分析
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摘要
目的:研究伴有同侧颈内动脉系统狭窄/闭塞性急性脑梗死患者影像学病灶模式特点及侧枝代偿情况。
方法:回顾性分析经全脑数字减影血管造影(digital subtract angiography,DSA)检查证实存在颈内动脉或大脑中动脉狭窄/闭塞64例急性脑梗死患者,临床分为颈内动脉(internal carotid artery, ICA)病变组、大脑中动脉(middle cerebral artery, MCA)病变组,研究二者影像学病灶模式(弥散小梗死、皮质下梗死、分水岭梗死、区域性梗死)特点,分析Willis环及次级代偿情况。
结果:64例患者中,ICA组43例,MCA组21例。四种病灶模式中分水岭梗死发生率ICA病变组较MCA病变组高(p=0.042);皮质下梗死发生率MCA病变组较ICA病变组高(p=0.046);ICA病变组:狭窄组16例,闭塞组27例,闭塞组眼动脉开放率较狭窄组高(p=0.004),四种病灶模式在上述二亚组中未见明显差异;ICA组:侧枝代偿发生率为83.7% (36/43),其中初级Willis环合并次级代偿发生率为,62.8%(27/43),Willis环前交通开放率为25.6%(11/43),后交通开放率为25.6%(11/43),次级代偿眼动脉代偿发生率41.9%(18/43),软脑膜支代偿发生率为41.9%(18/43)。
结论:颈内动脉狭窄或闭塞性急性脑梗死患者分水岭梗死较多见,其侧枝代偿方式以初级Willis环合并次级代偿为主,眼动脉开放在颈内动脉闭塞急性脑梗死患者较常见;大脑中动脉狭窄或闭塞患者皮质下梗死较多见。
Objectives: Analyzing image lesion patterns and collateral compensation to cerebral infarction patients with the system of ipsilateral internal carotid artery stenosis or occlusion.
Methods: Retrospective studying of sixty-four acute ischemic stroke patients with stenotic or occlusive ICA or MCA certified by cerebral angiography ,who were divided into two groups: ICA disease group and MCA disease group. We studied the character of image lesion patterns(territory infarcts, subcortical infarcts, border zone infarcts, and several disseminated small infarcts) and analyzing the information about the circle of Willis and second collateral compensation.
Results: There were 43 cases in ICA group, 21 cases in MCA group. In four infarct patterns, the incidence of border zone infarcts in ICA group was more often than MCA group(p=0.042), but the incidence of subcortical infarcts in MCA group was more often than in ICA group(p=0.046). There were 16 stenotic cases and 27 occlusive cases in ICA group, the occurrence rate of ophthalmic artery in occlusive group was more often than stenotic group. No obviously difference appeared about the four lession patterns in ICA subgroup. In ICA group, the incidence of collateral circulation was 83.7%, and the incidence of the circle of Willis mixed with the second collateral circulation was 62.8%, anterior communicating artery,25.6%, posterior communicating artery,25.6%, ophthalmic artery,41.9%, leptomeningeal artery ,41.9%.
Conclusions: Territory infarcts were more seen in acute cerebral infarction patients with ICA stenosis or occlusion, and the main Compensatory approach for those patients was the circle of Willis mixed with the second collateral circulation. The incidence rate of ophthalmic artery was more in ICA occlusive group than ICA stenotic group. Subcortical infarcts were more seen MCA stenotic or occlusive patients.
方法:回顾性分析经全脑数字减影血管造影(digital subtract angiography,DSA)检查证实存在颈内动脉或大脑中动脉狭窄/闭塞64例急性脑梗死患者,临床分为颈内动脉(internal carotid artery, ICA)病变组、大脑中动脉(middle cerebral artery, MCA)病变组,研究二者影像学病灶模式(弥散小梗死、皮质下梗死、分水岭梗死、区域性梗死)特点,分析Willis环及次级代偿情况。
结果:64例患者中,ICA组43例,MCA组21例。四种病灶模式中分水岭梗死发生率ICA病变组较MCA病变组高(p=0.042);皮质下梗死发生率MCA病变组较ICA病变组高(p=0.046);ICA病变组:狭窄组16例,闭塞组27例,闭塞组眼动脉开放率较狭窄组高(p=0.004),四种病灶模式在上述二亚组中未见明显差异;ICA组:侧枝代偿发生率为83.7% (36/43),其中初级Willis环合并次级代偿发生率为,62.8%(27/43),Willis环前交通开放率为25.6%(11/43),后交通开放率为25.6%(11/43),次级代偿眼动脉代偿发生率41.9%(18/43),软脑膜支代偿发生率为41.9%(18/43)。
结论:颈内动脉狭窄或闭塞性急性脑梗死患者分水岭梗死较多见,其侧枝代偿方式以初级Willis环合并次级代偿为主,眼动脉开放在颈内动脉闭塞急性脑梗死患者较常见;大脑中动脉狭窄或闭塞患者皮质下梗死较多见。
Objectives: Analyzing image lesion patterns and collateral compensation to cerebral infarction patients with the system of ipsilateral internal carotid artery stenosis or occlusion.
Methods: Retrospective studying of sixty-four acute ischemic stroke patients with stenotic or occlusive ICA or MCA certified by cerebral angiography ,who were divided into two groups: ICA disease group and MCA disease group. We studied the character of image lesion patterns(territory infarcts, subcortical infarcts, border zone infarcts, and several disseminated small infarcts) and analyzing the information about the circle of Willis and second collateral compensation.
Results: There were 43 cases in ICA group, 21 cases in MCA group. In four infarct patterns, the incidence of border zone infarcts in ICA group was more often than MCA group(p=0.042), but the incidence of subcortical infarcts in MCA group was more often than in ICA group(p=0.046). There were 16 stenotic cases and 27 occlusive cases in ICA group, the occurrence rate of ophthalmic artery in occlusive group was more often than stenotic group. No obviously difference appeared about the four lession patterns in ICA subgroup. In ICA group, the incidence of collateral circulation was 83.7%, and the incidence of the circle of Willis mixed with the second collateral circulation was 62.8%, anterior communicating artery,25.6%, posterior communicating artery,25.6%, ophthalmic artery,41.9%, leptomeningeal artery ,41.9%.
Conclusions: Territory infarcts were more seen in acute cerebral infarction patients with ICA stenosis or occlusion, and the main Compensatory approach for those patients was the circle of Willis mixed with the second collateral circulation. The incidence rate of ophthalmic artery was more in ICA occlusive group than ICA stenotic group. Subcortical infarcts were more seen MCA stenotic or occlusive patients.
引文
1. Caplan LR, Gorelick PB, Hier DB. Race, sex and occlusive cerebrovascular disease: A review. Stroke. 1986;17:648–655.
2. Wong KS, Huang YN, Gao S, Lam WW, Chan YL, Kay R. Intracranial stenosis in Chinese patients with acute stroke. Neurology. 1998;50:812–813.
3.李东波,田彦龙,宋冬雷,等. 120例颅内外脑供血动脉严重狭窄或闭塞患者全脑血管造影分析.国际脑血管病杂志.2009;17(2):98-103.
4. Wong KS, Gao S, Chan YL, Hansberg T, Lam WW, Droste DW, Kay R,Ringelstein EB. Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: a diffusion-weighted imaging and microemboli monitoring study. Ann Neurol. 2002;52:74–81.
5.段永伟,王拥军.磁共振对颈内动脉狭窄与闭塞患者卒中解剖模式诊断价值的初步探讨.中国卒中杂志,2009;8,650-655.
6. Man BL, Fu YP, Chan YY, Lam W, Hui AC, Leung WH, Mok V, Wong KS. Lesion patterns and stroke mechanisms in concurrent atherosclerosis of intracranial and extracranial vessels. Stroke. 2009 ;40(10):3211-3215.
7. Lee PH, Oh SH, Bang OY, Joo SY, Joo IS, Huh K. Infarct patterns in atherosclerotic middle cerebral artery versus internal carotid artery disease. Neurology. 2004;62:1291–1296.
8. Liebeskind DS, Cotsonis GA, Saver JL, Lynn MJ, Turan TN, Cloft HJ, Chimowitz MI; for the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Investigators. Collaterals dramatically alter stroke risk in intracranial atherosclerosis. Ann Neurol. 2010 Dec 14. doi: 10.1002/ana.22354.
9. Warach S, Gaa J, Siewert B, Wielopolski P, Edelman RR. Acute human stroke studied by whole brain echo planar diffusion-weighted magnetic resonance imaging. Ann Neurol. 1995;37(2):231–241.
10.中华医学会神经科分会.各类脑血管病诊断要点.中华神经精神科杂志,1996,29:379.
11. North American Symptomatic Carotid Endarteretomy Trail(NASCET) Steeringcommittee. North American Symptomatic Carotid Endarterectomy Trial-methods, patient characteristics, and progress[J]. Stroke. 1991, 22:711-720.
12. Gorelick,PB,Wong KS,Bae HJ ,et al. Large artery intracranial occlusive disease a large worldwide burden but a relatively neglected frontier. Stroke. 2008;39(8):2396-2399.
13. Bisschops RH, Klijn CJ, Kappelle LJ, van Huffelen AC, van der Grond J. Collateral flow and ischemic brain lesions in patients with unilateral carotid artery occlusion. Neurology. 2003 ;60(9):1435-1441.
14. H Yamauchi, T Kudoh, K Sugimoto, M Takahashi, Y Kishibe, H Okazawa. Pattern of collaterals, type of infarcts, and haemodynamic impairment in carotid artery occlusion. J Neurol Neurosurg Psychiatry 2004;75:1697–1701.
15. Feldmann E, Daneault N, Kwan E, Ho KJ, Pessin MS, Langenberg P, Caplan LR. Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology. 1990 ;40(10):1541-1545.
16. Wong LKS. Global burden of intracranial atherosclerosis. Int J Stroke. 2006;1:158–159.
17. Caplan LR, Wong KS, Gao S,et al. Is hypoperfusion an important cause of strokes? If so,how? Cerebrovasc Dis. 2006;21(3):145-153.
18. Seok Woo Yong, MD; Oh Young Bang, MD, PhD; Phil Hyu Lee, MD, PhD; Wen Yu Li, MD. Internal and cortical border-zone infarction clinical and diffusion-weighted imaging features. Stroke. 2006;37:841-846.
19. Del Sette M, Eliasziw M, Streifler JY, Hachinski VC, Fox AJ, Barnett HJ. Internal borderzone infarction: a marker for severe stenosis in patients with symptomatic internal carotid artery disease. For the North American Symptomatic Carotid Endarterectomy (NASCET) Group. Stroke. 2000;31:631–636.
20. Gandolfo C, Del Sette M, Finocchi C, Calautti C, Loeb C. Internal borderzone infarction in patients with ischemic stroke. Cerebrovasc Dis. 1998;8:255–258.
21. Kang DW, Chu K, Ko SB, Kwon SJ, Yoon BW, Roh JK. Lesion patterns and mechanism of ischemia in internal carotid artery disease: a diffusion-weighted imaging study. Arch Neurol. 2002;59:1577–1582.
22. Caplan LR. Intracranial branch atheromatous disease: a neglected, understudied, and underused concept. Neurology. 1989;39:1246–1250.
23. Fisher CM. Capsular infarcts: the underlying vascular lesions. Arch Neurol. 1979;36:65–73.
24. Adams HP, Damasio HC, Putman SF, et a1.Middle cerebral artery occlusion as a cause of isolated subcortical infarction. Stroke. 1983,14:948-952.
25. David S. Liebeskind, MD. Collateral Circulation. Stroke. 2003;34:2279-2284.
26. Hendrikse J, Hartkamp MJ, Hillen B, Mali WP, van der Grond J. Collateral ability of the circle of Willis in patients with unilateral internal carotid artery occlusion: border zone infarcts and clinical symptoms. Stroke. 2001;32(12):2768-2673.
27. Schomer DF, Marks MP, Steinberg GK, Johnstone IM, Boothroyd DB, Ross MR, Pelc NJ, Enzmann DR. The anatomy of the posterior communicating artery as a risk factor for ischemic cerebral infarction. N Engl J Med. 1994 ;330(22):1565-1570.
28. Hartkamp MJ, van Der Grond J, van Everdingen KJ, et al. Circle of Willis collateral flow investigated by magnetic resonance angiography[J]. Stroke.1999;30:2671- 2678.
29. D.R. Rutgers, MD; C.J.M. Klijn, MD; L.J. Kappelle, MD A.C. van Huffelen, MD; J. van der Grond, PhD. A Longitudinal Study of Collateral Flow Patterns in the Circle of Willis and the Ophthalmic Artery in Patients With a Symptomatic Internal Carotid Artery Occlusion. Stroke. 2000;31:1913-1920.
30. van Laar PJ, van der Grond J, Bremmer JP, Klijn CJ, Hendrikse J. Assessment of the contribution of the external carotid artery to brain perfusion in patients with internal carotid artery occlusion. Stroke. 2008 ;39(11):3003-3008.
31. Maas MB, Lev MH, Ay H, Singhal AB, Greer DM, Smith WS, Harris GJ, Halpern E, Kemmling A, Koroshetz WJ, Furie KL. Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke. 2009 ;40(9):3001-5.
32. Lima FO, Furie KL, Silva GS, Lev MH, Camargo EC, Singhal AB, Harris GJ, Halpern EF, Koroshetz WJ, Smith WS, Yoo AJ, Nogueira RG. The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long-term functional outcome in stroke patients with large vessel intracranial occlusion. Stroke. 2010;41(10):2316-2322.
1. Gorelick,PB,Wong KS,Bae HJ ,et al. Large artery intracranial occlusive disease a large worldwide burden but a relatively neglected frontier. Stroke. 2008;39(8):2396-2399.
2. Wong LKS. Global burden of intracranial atherosclerosis. Int J Stroke. 2006;1:158–159.
3. M. Barnett Robert D. Henderson, Michael Eliasziw, Allan J. Fox, Peter M. Rothwell and Henry J. Angiographically Defined Collateral Circulation and Risk of Stroke in Patients With Severe Carotid Artery Stenosis. Stroke 2000;31;128-132.
4. Lippert H, Pabst R. Arterial Variations in Man. Munich, Germany: JF Bergmann Verlag. 1985:92–93.
5.陈述花,于铁链,张云亭,等.正常国人Willis环形态的MRA研究.临床放射学杂志,2003,22:732.
6. Maas MB, Lev MH, Ay H, Singhal AB, Greer DM, Smith WS, Harris GJ, Halpern E, Kemmling A, Koroshetz WJ, Furie KL. Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke. 2009 Sep;40(9):3001-5.
7. D.R. Rutgers, MD; C.J.M. Klijn, MD; L.J. Kappelle, MD A.C. van Huffelen, MD; J. van der Grond, PhD. A Longitudinal Study of Collateral Flow Patterns in the Circle of Willis and the Ophthalmic Artery in Patients With a Symptomatic Internal Carotid Artery Occlusion. Stroke. 2000;31:1913-1920.
8. Toyoda K, Minematsu K, Yamaguchi T. Long-term changes in cerebral blood flow according to different types of ischemic stroke. J Neurol Sci. 1994;121:222–228.
9. Coyle P, Heistad DD. Development of collaterals in the cerebral circulation. Blood Vessels. 1991;28:183–189.
10. van Laar PJ, van der Grond J, Bremmer JP, Klijn CJ, Hendrikse J. Assessment of the contribution of the external carotid artery to brain perfusion in patients with internal carotid artery occlusion. Stroke. 2008 ;39(11):3003-8.
11. Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol. 1998;55:1475–1482.
12. Wang CX, Todd KG, Yang Y, Gordon T, Shuaib A. Patency of cerebral microvessels after focal embolic stroke in the rat. J Cereb Blood Flow Metab. 2001;21:413–421.
13. Lima FO, Furie KL, Silva GS, Lev MH, Camargo EC, Singhal AB, Harris GJ, Halpern EF, Koroshetz WJ, Smith WS, Yoo AJ, Nogueira RG. The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long-term functional outcome in stroke patients with large vessel intracranial occlusion. Stroke. 2010;41(10):2316-2322.
14. Ringelstein EB, Biniek R, Weiller C, Ammeling B, Nolte PN, Thron A. Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalization. Neurology. 1992;42:289–298.
15. Cohen JE, Ben-Hur T, Rajz G, Umansky F, Gomori JM. Endovascular stent-assisted angioplasty in the management of traumatic internal carotid artery dissections. Stroke. 2005 ;36(4):e45-7
16. Toni D, Fiorelli M, Bastianello S, Falcou A, Sette G, Ceschin V, Sacchetti ML, Argentino C. Acute ischemic strokes improving during the first 48 hours of onset: predictability, outcome, and possible mechanisms: a comparison with early deteriorating strokes. Stroke. 1997;28:10–14.
17. Qureshi AI. New grading system for angiographic evaluation of arterial occlusions and recanalization response to intra-arterial thrombolysis in acute ischemic stroke. Neurosurgery. 2002; 50:1405–1414; comment 1414–1415.
18. Kucinski T, Koch C, Eckert B, Becker V, Kromer H, Heesen C, Grzyska U, Freitag HJ, Rother J, Zeumer H. Collateral circulation is an independent radiological predictor of outcome after thrombolysis in acute ischaemic stroke. Neuroradiology. 2003; 45:11–18.
19. Vernieri F, Pasqualetti P, Matteis M, Passarelli F, Troisi E, Rossini PM,Caltagirone C, Silvestrini M. Effect of collateral blood flow and cerebral vasomotor reactivity on the outcome of carotid artery occlusion. Stroke.2001;32:1552–1558.
2. Wong KS, Huang YN, Gao S, Lam WW, Chan YL, Kay R. Intracranial stenosis in Chinese patients with acute stroke. Neurology. 1998;50:812–813.
3.李东波,田彦龙,宋冬雷,等. 120例颅内外脑供血动脉严重狭窄或闭塞患者全脑血管造影分析.国际脑血管病杂志.2009;17(2):98-103.
4. Wong KS, Gao S, Chan YL, Hansberg T, Lam WW, Droste DW, Kay R,Ringelstein EB. Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: a diffusion-weighted imaging and microemboli monitoring study. Ann Neurol. 2002;52:74–81.
5.段永伟,王拥军.磁共振对颈内动脉狭窄与闭塞患者卒中解剖模式诊断价值的初步探讨.中国卒中杂志,2009;8,650-655.
6. Man BL, Fu YP, Chan YY, Lam W, Hui AC, Leung WH, Mok V, Wong KS. Lesion patterns and stroke mechanisms in concurrent atherosclerosis of intracranial and extracranial vessels. Stroke. 2009 ;40(10):3211-3215.
7. Lee PH, Oh SH, Bang OY, Joo SY, Joo IS, Huh K. Infarct patterns in atherosclerotic middle cerebral artery versus internal carotid artery disease. Neurology. 2004;62:1291–1296.
8. Liebeskind DS, Cotsonis GA, Saver JL, Lynn MJ, Turan TN, Cloft HJ, Chimowitz MI; for the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Investigators. Collaterals dramatically alter stroke risk in intracranial atherosclerosis. Ann Neurol. 2010 Dec 14. doi: 10.1002/ana.22354.
9. Warach S, Gaa J, Siewert B, Wielopolski P, Edelman RR. Acute human stroke studied by whole brain echo planar diffusion-weighted magnetic resonance imaging. Ann Neurol. 1995;37(2):231–241.
10.中华医学会神经科分会.各类脑血管病诊断要点.中华神经精神科杂志,1996,29:379.
11. North American Symptomatic Carotid Endarteretomy Trail(NASCET) Steeringcommittee. North American Symptomatic Carotid Endarterectomy Trial-methods, patient characteristics, and progress[J]. Stroke. 1991, 22:711-720.
12. Gorelick,PB,Wong KS,Bae HJ ,et al. Large artery intracranial occlusive disease a large worldwide burden but a relatively neglected frontier. Stroke. 2008;39(8):2396-2399.
13. Bisschops RH, Klijn CJ, Kappelle LJ, van Huffelen AC, van der Grond J. Collateral flow and ischemic brain lesions in patients with unilateral carotid artery occlusion. Neurology. 2003 ;60(9):1435-1441.
14. H Yamauchi, T Kudoh, K Sugimoto, M Takahashi, Y Kishibe, H Okazawa. Pattern of collaterals, type of infarcts, and haemodynamic impairment in carotid artery occlusion. J Neurol Neurosurg Psychiatry 2004;75:1697–1701.
15. Feldmann E, Daneault N, Kwan E, Ho KJ, Pessin MS, Langenberg P, Caplan LR. Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology. 1990 ;40(10):1541-1545.
16. Wong LKS. Global burden of intracranial atherosclerosis. Int J Stroke. 2006;1:158–159.
17. Caplan LR, Wong KS, Gao S,et al. Is hypoperfusion an important cause of strokes? If so,how? Cerebrovasc Dis. 2006;21(3):145-153.
18. Seok Woo Yong, MD; Oh Young Bang, MD, PhD; Phil Hyu Lee, MD, PhD; Wen Yu Li, MD. Internal and cortical border-zone infarction clinical and diffusion-weighted imaging features. Stroke. 2006;37:841-846.
19. Del Sette M, Eliasziw M, Streifler JY, Hachinski VC, Fox AJ, Barnett HJ. Internal borderzone infarction: a marker for severe stenosis in patients with symptomatic internal carotid artery disease. For the North American Symptomatic Carotid Endarterectomy (NASCET) Group. Stroke. 2000;31:631–636.
20. Gandolfo C, Del Sette M, Finocchi C, Calautti C, Loeb C. Internal borderzone infarction in patients with ischemic stroke. Cerebrovasc Dis. 1998;8:255–258.
21. Kang DW, Chu K, Ko SB, Kwon SJ, Yoon BW, Roh JK. Lesion patterns and mechanism of ischemia in internal carotid artery disease: a diffusion-weighted imaging study. Arch Neurol. 2002;59:1577–1582.
22. Caplan LR. Intracranial branch atheromatous disease: a neglected, understudied, and underused concept. Neurology. 1989;39:1246–1250.
23. Fisher CM. Capsular infarcts: the underlying vascular lesions. Arch Neurol. 1979;36:65–73.
24. Adams HP, Damasio HC, Putman SF, et a1.Middle cerebral artery occlusion as a cause of isolated subcortical infarction. Stroke. 1983,14:948-952.
25. David S. Liebeskind, MD. Collateral Circulation. Stroke. 2003;34:2279-2284.
26. Hendrikse J, Hartkamp MJ, Hillen B, Mali WP, van der Grond J. Collateral ability of the circle of Willis in patients with unilateral internal carotid artery occlusion: border zone infarcts and clinical symptoms. Stroke. 2001;32(12):2768-2673.
27. Schomer DF, Marks MP, Steinberg GK, Johnstone IM, Boothroyd DB, Ross MR, Pelc NJ, Enzmann DR. The anatomy of the posterior communicating artery as a risk factor for ischemic cerebral infarction. N Engl J Med. 1994 ;330(22):1565-1570.
28. Hartkamp MJ, van Der Grond J, van Everdingen KJ, et al. Circle of Willis collateral flow investigated by magnetic resonance angiography[J]. Stroke.1999;30:2671- 2678.
29. D.R. Rutgers, MD; C.J.M. Klijn, MD; L.J. Kappelle, MD A.C. van Huffelen, MD; J. van der Grond, PhD. A Longitudinal Study of Collateral Flow Patterns in the Circle of Willis and the Ophthalmic Artery in Patients With a Symptomatic Internal Carotid Artery Occlusion. Stroke. 2000;31:1913-1920.
30. van Laar PJ, van der Grond J, Bremmer JP, Klijn CJ, Hendrikse J. Assessment of the contribution of the external carotid artery to brain perfusion in patients with internal carotid artery occlusion. Stroke. 2008 ;39(11):3003-3008.
31. Maas MB, Lev MH, Ay H, Singhal AB, Greer DM, Smith WS, Harris GJ, Halpern E, Kemmling A, Koroshetz WJ, Furie KL. Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke. 2009 ;40(9):3001-5.
32. Lima FO, Furie KL, Silva GS, Lev MH, Camargo EC, Singhal AB, Harris GJ, Halpern EF, Koroshetz WJ, Smith WS, Yoo AJ, Nogueira RG. The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long-term functional outcome in stroke patients with large vessel intracranial occlusion. Stroke. 2010;41(10):2316-2322.
1. Gorelick,PB,Wong KS,Bae HJ ,et al. Large artery intracranial occlusive disease a large worldwide burden but a relatively neglected frontier. Stroke. 2008;39(8):2396-2399.
2. Wong LKS. Global burden of intracranial atherosclerosis. Int J Stroke. 2006;1:158–159.
3. M. Barnett Robert D. Henderson, Michael Eliasziw, Allan J. Fox, Peter M. Rothwell and Henry J. Angiographically Defined Collateral Circulation and Risk of Stroke in Patients With Severe Carotid Artery Stenosis. Stroke 2000;31;128-132.
4. Lippert H, Pabst R. Arterial Variations in Man. Munich, Germany: JF Bergmann Verlag. 1985:92–93.
5.陈述花,于铁链,张云亭,等.正常国人Willis环形态的MRA研究.临床放射学杂志,2003,22:732.
6. Maas MB, Lev MH, Ay H, Singhal AB, Greer DM, Smith WS, Harris GJ, Halpern E, Kemmling A, Koroshetz WJ, Furie KL. Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke. 2009 Sep;40(9):3001-5.
7. D.R. Rutgers, MD; C.J.M. Klijn, MD; L.J. Kappelle, MD A.C. van Huffelen, MD; J. van der Grond, PhD. A Longitudinal Study of Collateral Flow Patterns in the Circle of Willis and the Ophthalmic Artery in Patients With a Symptomatic Internal Carotid Artery Occlusion. Stroke. 2000;31:1913-1920.
8. Toyoda K, Minematsu K, Yamaguchi T. Long-term changes in cerebral blood flow according to different types of ischemic stroke. J Neurol Sci. 1994;121:222–228.
9. Coyle P, Heistad DD. Development of collaterals in the cerebral circulation. Blood Vessels. 1991;28:183–189.
10. van Laar PJ, van der Grond J, Bremmer JP, Klijn CJ, Hendrikse J. Assessment of the contribution of the external carotid artery to brain perfusion in patients with internal carotid artery occlusion. Stroke. 2008 ;39(11):3003-8.
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