DSA Study Of The Contition In Patients With Carotid Artery System Stenosis Or Occlusion

Objective To study the major pattern,features and the influencing factors of creation and compensation of collateral circulation,forther explore the relationship between collateral circulation and patient's clinical symptoms.Methods 68 patients whose internal carotid artery system were stenosal or occlusive conformed by DSA examination.These patients were divided into symptomatic groups (including the infarct group, TIA group), asymptomatic group by clinical and eiconic appearance; divided into low-grad stenosis group, midrange stenosis group, severe stenosis group, and occlusive group. setting up 20 patients whose results of DSA examination were normal over the same period, having no ischemic brain disease, as control group. Each patients underwent selective cerebral angiography. Record position,degree of the carotid artery stenosis or occlusion,the existence of collateral opening,collateral type,the variation of the Willis ring, score collateral flow of all patients whose internal carotid artery were occlusive. We input and analyzed the data using SPSS15.0. numeration data were analyzed using the chi-square tests and measurement data using variance method,P <0.05 as statistically significant difference.Results①Among 68 patients, the number of stenosis or occlusion taken place in ICA is 41(E-ICA 26, X-ICA 15), MCA 17, A1 segment of ACA 4, distal A1 segment of ACA 6;The numbers of opened collateral circulation respectively were: ACOA 33,PCOA 22, post leptomeningeal anastomosis 27,former leptomeningeal anastomosis 19,ophthalmic artery 4,perforating branches 2,the others 9.The proportion of opened collateral circulation of serious stenosis group and occlusion group were the highest,they respectively are 72.7% and 86.7% ,they were different from control group significantly(p <0.001);mild and moderate stenosis groups respectively were 16.7% and 20.0%,having no significant difference from control group(p= 0.676,p= 0.551).②The proportion of opened primary collateral circulation:symptomatic group was less than asymptomatic group (p = 0.042); the proportion of opened secondary collateral circulation: Symptomatic group was more than asymptomatic group (p= 0.022); The proportion of opened anterior communicating artery: symptomatic group was less than asymptomatic group (p= 0.038); the proportion of opened posterior communicating artery: Symptomatic group and asymptomatic group were same (p= 0.382).③The ratio of variation of Pre-circle: symptomatic group was the highest ,followed by the normal control group ,while the lowest rate of variation was asymptomatic group (p= 0.032); The ratio of variation of post-circle: no significant difference among the three groups (p = 0.110).④Occlusion of internal carotid artery were found in 26 cases, collateral flow scores: infarct group received the lowest score of 2.4286±0.17271, followed by the TIA group of 3.2500±0.2500, the asymptomatic group was the highest of 3.7500±0.16366. the difference among the three groups was significant (p<0.001).Conclusion The stenosis or occlusion of internal carotid artery can cause all kinds of collateral circulation open. Primary collateral circulation is the dominant way of complementarity. The establishment of secondary collateral circle is a sign of severe brain ischemia. The using of DSA to analysis and evaluate the conditions of collateral circulation of patients has a very important clinical value.