经颅多普勒超声联合颈动脉超声对颈内动脉病变患者脑侧支循环与缺血性卒中的相关性研究

Correlation between cerebral collateral circulation and ischemic stroke in patients with internal carotid artery lesions assessed by transcranial Doppler ultrasound combined with carotid ultrasound

摘要:

目的 旨在通过经颅多普勒超声和颈动脉超声的联合应用，探讨单侧颈内动脉颅外段（EICA）重度狭窄或闭塞患者的颅内侧支循环开放类型及其与发生缺血性卒中的相关性。方法 纳入2023年1月至2024年12月陆军军医大学第二附属医院神经内科收治的73例单侧EICA重度狭窄或闭塞患者，根据是否发生缺血性卒中分为观察组（43例）与对照组（30例）。所有受试者均接受经颅多普勒超声与颈动脉超声联合检查。通过经颅多普勒超声判定侧支循环开放类型与程度，记录患侧大脑中动脉收缩期峰值流速（PSV）、搏动指数（PI）等血流动力学参数。对比两组侧支循环特征与血流指标差异。采用多因素Logistic回归分析评估发生缺血性卒中的危险因素。结果 两组EICA狭窄程度（重度或闭塞）分布比较，差异无统计学意义（P>0.05）。对照组侧支循环总开放率、一级侧支开放率均高于观察组，二级侧支开放率显著低于观察组，差异有统计学意义（P<0.05）；其中一级+二级侧支联合开放率两组比较，差异无统计学意义（P>0.05）。观察组患侧大脑中动脉PSV和PI水平均低于对照组（P<0.001）。点二列相关分析显示，患侧大脑中动脉PSV和PI水平与发生缺血性卒中呈负相关（r=-0.976，P<0.001；r=-0.921，P<0.001）。多因素Logistic回归分析显示，一级侧支循环未开放、患侧大脑中动脉PSV和PI水平降低是EICA重度狭窄或闭塞患者发生缺血性卒中的危险因素（P<0.05）。结论 经颅多普勒超声联合颈动脉超声可精准评估EICA重度狭窄或闭塞患者的侧支循环代偿状态与脑血流动力学改变，一级侧支开放效能及大脑中动脉PSV和PI水平与缺血性卒中发生密切相关，可作为缺血性卒中风险分层的无创评估手段。

Abstract:

Objective To explore the type of intracranial collateral circulation recruitment and its correlation with the occurrence of ischemic stroke in patients with unilateral severe stenosis or occlusion of the extracranial segment of the internal carotid artery （EICA） through the combined application of transcranial Doppler ultrasound and carotid ultrasound.Methods A total of 73 patients with unilateral severe EICA stenosis or occlusion admitted to the Department of Neurology， The Second Affiliated Hospital of Army Medical University， between January 2023 and December 2024 were enrolled. They were divided into an observation group （43 cases） and a control group （30 cases） based on the occurrence of ischemic stroke. All subjects underwent combined transcranial Doppler ultrasound and carotid ultrasound examinations. Transcranial Doppler ultrasound was used to determine the type and extent of collateral circulation recruitment， and hemodynamic parameters such as peak systolic velocity （PSV） and pulsatility index （PI） of the ipsilateral middle cerebral artery were recorded. Differences in collateral circulation characteristics and hemodynamic parameters were compared between the two groups. A multivariable logistic regression analysis was used to evaluate the risk factors for the occurrence of ischemic stroke.Results There was no significant difference in the distribution of EICA stenosis severity （severe stenosis or occlusion） between the two groups （P>0.05）. The total recruitment rate of collateral circulation and the recruitment rate of primary collateral circulation in the control group were significantly higher than those in the observation group， while the recruitment rate of secondary collateral circulation was significantly lower than that in the observation group （P<0.05）. There was no significant difference in the combined recruitment rate of primary and secondary collaterals between the two groups （P>0.05）. The values of PSV and PI of the ipsilateral middle cerebral artery in the observation group were significantly lower than those in the control group （P<0.001）. Point-biserial correlation analysis showed that PSV and PI values of the ipsilateral middle cerebral artery were negatively correlated with the occurrence of ischemic stroke （r=-0.976， P<0.001； r=-0.921， P<0.001）. The multivariable logistic regression analysis showed that non-recruitment of primary collateral circulation and decreased PSV and PI values of the ipsilateral middle cerebral artery were risk factors for ischemic stroke in patients with severe EICA stenosis or occlusion （P<0.05）.Conclusions Transcranial Doppler ultrasound combined with carotid ultrasound can accurately evaluate the compensatory status of collateral circulation and cerebral hemodynamic changes in patients with severe EICA stenosis or occlusion. The recruitment capacity of primary collaterals and the values of PSV and PI of the middle cerebral artery are closely related to the occurrence of ischemic stroke， which can be used as non-invasive indicators for ischemic stroke risk stratification.