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中华脑血管病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 185 -190. doi: 10.11817/j.issn.1673-9248.2021.03.010

综述

侧支循环及其在缺血性脑卒中诊疗中的研究和应用现状
金巍1, 尹豆1, 李彬寅1, 胡震2, 刘军1,()   
  1. 1. 200025 上海交通大学医学院附属瑞金医院神经内科
    2. 200025 上海交通大学医学院附属瑞金医院神经内科;200020 上海交通大学医学院附属瑞金医院卢湾分院脑病中心
  • 收稿日期:2021-04-29 出版日期:2021-06-01
  • 通信作者: 刘军
  • 基金资助:
    上海市卫生健康委员会临床专项(20204Y0131)

Collateral circulation in diagnosis and treatment of ischemic stroke and related application

Wei Jin1, Dou Yin1, Binyin Li1, Zheng Hu2, Jun Liu1,()   

  1. 1. Department of Neurology, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    2. Department of Neurology, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Encephalopathy Center, Ruijin Hospital Luwan Branch Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
  • Received:2021-04-29 Published:2021-06-01
  • Corresponding author: Jun Liu
引用本文:

金巍, 尹豆, 李彬寅, 胡震, 刘军. 侧支循环及其在缺血性脑卒中诊疗中的研究和应用现状[J]. 中华脑血管病杂志(电子版), 2021, 15(03): 185-190.

Wei Jin, Dou Yin, Binyin Li, Zheng Hu, Jun Liu. Collateral circulation in diagnosis and treatment of ischemic stroke and related application[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2021, 15(03): 185-190.

急性缺血性脑卒中发病率高、致死率高、致残率高,给我国医疗卫生及国民健康造成了严重负担。时间窗或组织窗内进行血管开通是急性缺血性脑卒中治疗的首选,但仍有一部分患者在血管开通治疗后预后欠佳,其可能与患者侧支循环条件不良有关。侧支循环评估手段众多,其中数字剪影血管造影为金标准,CT血管造影是最常采用的手段。多项研究证实侧支循环条件与静脉溶栓、血管内治疗的预后有关,可以作为判断缺血性脑卒中预后的预测指标。随着影像技术的发展,侧支循环的重要性逐渐被认知,鉴于其与缺血性脑卒中等脑血管病的病理生理关系密切,可作为潜在的干预靶点辅助治疗,相关领域仍需进一步研究证实。

With high morbidity, mortality, and high disability rate, acute ischemic stroke brings a heavy burden on our public health. Artery recanalization is still the first line treatment strategy of ischemic stroke. However, quite a few patients who have received artery recanalization were still with poor outcome. Poor collateral circulation might be the cause. Various vascular examinations can be used to evaluate collateral circulation, among which DSA (digital substraction angiography) is the golden standard while CTA (computed tomography angiography) is the most common used. A few trials have found that collateral circulation is associated with the outcome of recanalization treatment, which can predict the prognosis of ischemic stroke. With advancement of radiology, the importance of collateral circulation is being recognized. With the close relation with the pathophysiology of ischemic stroke and its potential application in treatment, more trials in collateral circulation are needed.

图1 三级侧支循环及Christoforidis评分示意图。图a为一例40岁女性烟雾病患者,数字剪影血管造影可见左侧大脑中动脉闭塞,颅底新生血管网形成;图b为Christoforidis评分示意图
表1 基于DSA的侧支循环评分系统
表2 基于CTA的侧支循环评分系统
评分系统 评分标准
改良ASITN/SIR评分系统

0级

缺血区域在任何时间都无脑膜侧支可见

1级

缺血区域直到晚期静脉相才可见部分侧支

2级

缺血区域在静脉相前期可见部分侧支

3级

缺血区域在晚期静脉相可见完全侧支

4级

缺血区域在静脉相前期可见完全侧支

备注

0~1级为侧支循环不足,2级为侧支循环一般,3~4级为侧支循环良好
基于单时相CTA的ASPECTS侧支评分系统

0级

梗阻远端增强血管模糊或不可见

1级

梗阻远端增强血管较对侧相同部位稀疏

2级

梗阻远端增强血管与对侧相同部位相当

备注

满分20,为10个区域(6个皮层区域、内囊、尾状核、导叶、豆状核)得分总和,分数越高代表侧支循环越好
基于多时相CTA的ASPECTS侧支评分系统

0级

缺血区域在任何时相都无侧支可见

1级

缺血区域在任何时相仅有少量侧支可见

2级

缺血区域远端侧支延迟2时相,血管变细;或延迟1时相,血管稀疏

3级

缺血区域远端侧支延迟2时相,血管正常;或延迟1时相,部分血管变细或稀疏

4级

缺血区域远端侧支延迟1时相,血管正常

5级

缺血区域远端侧支无延迟,血管正常

备注

0~1级为侧支循环不足,2~3级为侧支循环一般,4~5级为侧支循环良好
Tan评分系统

0级

梗阻的中动脉区缺少侧支供血

1级

梗阻的中动脉区侧支供血>0但≤50%

2级

梗阻的中动脉区侧支供血>50%但≤100%

3级

梗阻的中动脉区侧支完全供血
Miteff中动脉侧支评分系统

1级

中动脉远端皮层支少见血管增强

2级

外侧裂可见血管

3级

中动脉梗阻区域远端可见侧支形成
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