Relevant research of collateral circulation and infarct types and cerebral perfusion in patients with middle cerebral artery severe stenosis or occlusion
10.3969/j.issn.1672-592.2019.01.005
- Author:
Mingsi ZHANG
1
Author Information
1. Department of Neurology, Central War Zone General Hospital of PLA
- Publication Type:Journal Article
- Keywords:
Collateral circulation;
Lesion type;
Middle cerebral artery;
Perfusion imaging
- From:
Chinese Journal of Cerebrovascular Diseases
2019;16(1):16-21
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the effects of collateral circulation on the infarct types and cerebral perfusion state in patients with unilateral middle cerebral artery (MCA) severe stenosis or occlusion. Methods From January 2013 to June 2018,144 consecutivc patients with unilateral MCA severe stenosis or occlusion admitted to the Department of Neurology, Central War Zone General Hospital of PLA and diagnosed with 320-row Ct angiography were enrolled retrospectively. According to the collateral circulation,they were divided into good collateral circulation group (n =67) and reduced collateral circulation group (n -11). The infarct types were compared and analyzed between the two groups (perforator artery infarction [PAIJ ,pial infarct [PI] .large territory infarct [LTI] .and border-zone infarction [BZI] including corticle border-zone infarct (CBZI) .internal border-zone infarct (IBZI) and mixed BZI [MT.CBZI with IBZI]) and cerebral perfusion parameters (time to peak [11Y], cerebral blood volume [CBV],mean transit time [MTT] .cerebral blood flow [CBF] and ratio of affected side to normal side (affected side and healthy side,rCBV.rCBF, rTTP, and rMTT) between the two groups. SPSS22. 0 statistical software was used for data analysis and processing. Results (1) In 144 patients with unilateral MCA severe stenosis or occlusion,67 had good collateral circulation,77 had reduced collateral circulation. The occurrence of different types of infarction is as follows:PAI in 18 cases,PI in 11 cases,LTI in 18 cases,CBZI in 13 cases, IBZI in 32 cases, MT in 13 cases, MI in 17 cases, and non-infarction in 22 cases (including transient ischemic attack in 14 cases). In the good collateral circulation group, the proportion of patients with non-infarction was the highest (16 cases,23. 9%) and the proportion of LTI was the lowest (4 cases, 6. 0%) , while the proportion of IBZI was the highest (26 cases,33. 8%) and the proportion of PI was the lowest (4cases,5. 2%) in the reduced collateral circulation group. There was significant difference in the distribution of different types of infarction between the two groups (P <0. 01). (2) The results of comparison of cerebral perfusion parameters between the healthy side and the affected side in patients with different collateral circulation showed that the CBV (2. 48 ±0. 43 ml/100 g) of the affected side in patients with good collateral was increased significantly ,TTP (16.0 ±3.1 s) and MTT (4.4 ±0. 9 s) were prolonged significantly. The differences were statistically significant (all P <0.01). The TTP (18. 9 ±2.7 s) on the affected side in the reduced collateral group was significantly prolonged,MTT (3.8 ± 1.0s) was significantly shortened,and CBF (38 ± 13ml/100g • min) was significantly increased The differences were statistically significant (all P<0.01). (3) Comparison of cerebral perfusion parameters in patients with different collateral circulation,i€BV and rMTT (1.07 ±0l 15 and 1.06 ±0.15respectively) in the good collateral circulation group were higher than tlwse (Ol 98 ±0l 19 and 0.89 ±0l 20respectively) in the reduced collateral circulation group .while rTTP and rCBF (1. 12 ±0. 09 and 1. 03 ±0. 21 respectively) in the good collateral circulation group were lower than those (1.20 ±0.09 and 1. 12 ±0.29 respectively) in the reduced collateral circulation group. The differences were statistically significant (all P < 0. 05) . Conclusion Good collateral circulation can compensate for cerebral perfusion in patients with unilateral MCA severe stenosis or occlusion to prevent the occurrence of cerebral infarction or reduce the infarct size.
