Study On The Artery Morphological Changes And Compensatory Circulation Of The Patients With Posterior Circulation Ischemia With DSA

Objective:Purposes of the present study were to evaluate the abnormal status of the definite PCI patients'vas morphologic on DSA and the collateral pathways of the posterior circulation, combining it with clinic and neuroimaging, quantifying some collateral vessels, and discuss the relationship between the type of collateral pathways and the vas morphologic, quantify some collateral vessels, evaluating the compensatory significance, providing a more reliable basis for the treatment and better prognosis.Materials and Methods:Selecting 60 definite patients with PCI that were treated in neuron-medical department in Lianyungang TCM Hospital from March, 2006 to March, 2008 as experiment group, and a 58 healthy as controls, which were matched with the PCI cases in age, sex and other basic conditions. They were all given selective cerebral angiography. We counted the changes in abnormal status and the presences rate of collateral pathways, measured the diameter of the cerebral vessels, combining this with clinic and neuroimaging information (CT, MRI), and studied the relationship between the sorts and the presences of collateral pathways and the abnormal status of the vas morphology.Results:1,50(83.3%) patients showed abnormal vascular structures in neck and brain in the 60 patients with PCI, which included 8 patients(13.3%) with pure anterior circulation lesion, 29 patients(48.3%) with posterior circulation lesion and 13 patients(21.6%) with both. There was no vessel structural abnormity in other 10 cases (16.6%). 2,The distribution of simple anterior circulation lesion: only 5 patients showed stenosis in internal carotid artery and 3 patients showed stenosis in internal carotid artery and MCA. In 12 lesions of internal carotid artery, there were 3 vessels with mild stenosis, 8 vessels with significant stenosis and 1vessels with high-grade stenosis.3,The distribution of PC lesion: 4 patients showed stenosis in the initiation of SCA, one of whom showed steal phenomenon. 14 patients showed lesion in the left vertebral artery, with 6 vessels with stenosis in initial segment and one with stenosis in initial segment pulsing Vertebral-Artery Dissection, 2 vessels with stenosis in intracalvarium, 10-formyltetrahydrofolate synthase serial stenosis in cervical segment, 1 vessel with 360 distortion, and 3 vessels with dysplasia and 1 with dysplasia pulsing mild stenosis in PCoA. 13 patients showed lesion in the right vertebral artery, which were 7 vessels with dysplasia and 1 with dysplasia pulsing occlusion in unilateral posterior cerebral artery, 3 vessels with stenosis in initial segment, 1 vessel with stenosis in intracalvarium and 1 with occlusion. 5 patients were found lesion in bilateral vertebral arteries, 3 only in BA and 3 in posterior cerebral artery, of whom 2 showed dysplasia and 1 occlusion in posterior cerebral artery. The classification of abnormality vertebral artery were 1â… type, 4â…¡, and 9â…¢on the left and 9â…¡, 3â…¢and 1â…£type on the right.4,The collateral circulation pathways. There were 15 vessels open in PCOA, of which 3 with patency in both sides, 7 cases became thicken in anterior choroidal artery, and 5 with ramus anastomoticus in ECA cerebral piamater. 12 cases were found thickening in thyrocervical trunk, 4 in deep rami muscu lares, 6 in muscular branch of arteria cervicalis profunda and 4 in PICA.Conclusions:There are different morphological changes in the patients with PCI and. some of these result from anterior circulation lesion.The state of collateral circulation is closely associated with different morphological changes. (1) The patency and thickening of both thyrocervical trunk and PCOA are the main compensations to the lesion of SCA and the initial segment of VA. (2) The patency and thickening of PCOA and ACHA are the main compensations to the lesion in intracalvarium of VA. (3)The patency and thickening of thyrocervical trunk and PCOA and cerebral piamater ramus anastomoticus of ECA are the main compensations to the dysplasia of VA. (4) The patency and thickening of PCOA and the muscular branch of arteria cervicalis profunda and PICA are the main compensations to the lesion BA.