| Objective:Record of the risk factors of patients whose internal carotid artery were severe stenosis or occlusion and use neuroimaging method to evaluate patients in brain structural imaging, angiography and the perfusion. And explore of pathogenesis and the mechanism of collateral circulation combining with clinical features and cognitive evaluation of patients.we aim to offer the fountion of setting up clinical and imaging diagnostic assessment system of internal carotid artery severe stenosis or occlusion, and normalized individual intervention.Methods:Collect98patients who have chemia cerebrovascular disease with severe stenosis or occlusion of internal carotid artery in the ward from the clinic in Tianjin general hospital from March2012till April2013. All the patients have been completed some related chemical and clinical data. Structure imaging and angiography examinations(MRI、neck vascular ultrasound、MRAorCTA) are applied to all the patients.Among them, part of patients received the examination cerebral blood perfusion by SPECT and the cognitive function by MMSE, MoCA.Collect55patients with severe stenosis or occlusion of ICA and21patients with severe stenosis or occlusion of MCA in the ward from the clinic in Tianjin general hospital from March2006till April2013.All the76patients receive the examination of DSA and20of them with complete clinical data receive the examination of SPECT and We evaluated the cognitive function by MMSE, MoCA. We divided the patients into three groups according the site of stenosis or occlusion and compared and analyzed the risk factors、infract form、collateral circulation、regional cerebral blood perfusion and cognitive function and the relation among them.Results:1According to multiple regression analysis, we detected that smoking and mellitus is related to severe stenosis or occlusion of extracranial internal carotid artery while the smoking and mellitus is the isolated dangerous factor of of severe stenosis or occlusion of symptomatic extracranial internal carotid artery2Among98patients, there were55patients with infarct in the anterior circulation, including21watershed infract (3anterior watershed infract,7posterior watershed infract,6internal watershed infract and5posterior and internal watershed infract),15cortex infract,8perforating artery infarct and7large area infarct. there were9patients with infarct in the posterior circulation, among them there was2patients with no responsible artery stenosis or occlusion. Cortical infarction is more often seen in the group of extracranial internal carotid artery(41.7%), there is statistical significance between the group extracranial and concurrent stenosis or occlusion of internal carotid artery (P=0.026<0.05); the group of concurrent stenosis or occlusion of internal carotid artery has the most form of infract-watershed infract.lt is more frequently observed in comparison with the group of extracranial internal carotid artery.No large area infarct was found in patients with the opening of anterior communicating artery,while4patients without anterior communicating artery had large area infarct (P<0.05)3Under DSA,55patients whose ICA were severe stenosis or occlusion was observed more frequently with the circle of Willis as the major collateral pathway; in contrast, leptomeningeal channels were the major collateral circulation of MCA in21patients. New blood capillary were found in1patients with severe stenosis or occlusion of ICA.4The examination of MRI is more sensitive about ischemic damage in thalamus and basal ganglia than SPECT(P<0.01); The examinaition of SPECT is more sensitive about ischemic damage in the lobe than MRI (P<0.01).5the rCBF of affected side was lower at frontal, temporal, parietal, occipital cortices, basal ganglia and thalamus,among them the rCBF at frontal, temporal, basal ganglia deceased significantly (P<0.05)6The rCBF at temporal lobe of the right side has positive correlation with the faculty of memory (P=0.375、0.011) and there is a positive correlation between the faculty of attention and calculation and The rCBF at frontal lobe of the left side (r=0.315,P=0.035)7Under CTA or MRA,The rCBF at frontal lobe of the affected side had positive correlation with the opening of the anterior communicating artery (S=0.442, P=0.027), while the rCBF of occipital lobe had no abvious correlation with the opening of the posterior communicating artery. There is difference in statistics in the domain of excusive ablity, attention, calculation between the patients whose anterior communicating artery were open or not, while the differenceuation was not seen in the situation of posterior communicating artery.8Patients with primary collateral circulation open comparing with secondary collateral circulation open, the occurrence of infarction have no statistical difference (P<0.05). the rCBF of temporal lobe with the secondary collateral circulation open was obviously higher than that of primary collateral circulation open, the difference was statistically significant (P<0.05).There were4LM open in5patients who had secondary collateral circulation. There is a no abvious correlation between the opening of collateral circulation and cognitive function.9The group of Infarction are lower than the non-infarction group in MMSE and MOCA scores and in the field of language, the difference was statistically significant (P<0.05).Conclusion:1Comparing among the different sites of, smoking and mellitus is the isolated dangerous factor of of severe stenosis or occlusion of symptomatic extracranial internal carotid artery.2Different infarct forms can be seen in severe stenosis or occlusion of ICA including large area infarct、cortex infract、perforating artery infarct and watershed infract, the group of concurrent stenosis or occlusion of internal carotid artery has the most form of infract.Cortical infarction is more often seen in the group of extracranial internal carotid artery.3The opening of AcoA can reduce the incidence of large area of infarction.ICA was observed more frequently with the circle of Willis as the major collateral pathway; in contrast, leptomeningeal channels were the major collateral circulation of MCA. In patients with severe cerebral arterial stenosis or occlusion, the primary、secondary and tertiary collateral circulation can all exist.4The SPECT could be sensitive measurement in the detection in early stage, the rCBF of affected side was lower at frontal, temporal, parietal, occipital cortices, basal ganglia and thalamus,among them the rCBF at frontal. there is a positive correlation between the faculty of attention and calculation and The rCBF at frontal lobe of the left side. Patients with severe stenosis or occlusion of ICA directly lead to vascular cognitive dysfunction because of regional cerebral blood flow changes in the early stage.5AcoA is an important pathway of the primary collateral circulation, which can improve rCBF at frontal lobe and the cognitive function,especially in the domain of excusive ablity, attention, calculation. LM is an important pathway of the secondary collateral circulation.The occurrence of the secondary collateral circulation can not reduce the occurrence of infarction, but the region cerebral blood flow of frontal, parietal、temporal and thalamus had increasing trend,especially in the temporal lobe. While the congnitive function had not been improved.In conclusion:We should evaluate patients in terms of medical history、clinical symptoms、structure imaging、angiography、perfusion and cognitive function,with the result of assessing the patients with severe stenosis or occlusion of internal carotid artery in every respect. In Surgical intervention, we should not only evaluate the vascular stenosis degree of vessel, but also make evaluation of collateral circulation, cerebral blood perfusion and cognitive function on the bsasis of structural damage, thus propose standard therapeutic schedule. In addition, in order to improve the quality of life of patients, early screening and the rational intervention are also necessary for patients who have vascular cognitive impairment. |
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