【摘要】 目的：探讨TCD无创评估颈动脉重度狭窄及闭塞患者颅内侧支循环开放的血流动力学特征及其与临床预后的相关性。方法：采用回顾性队列研究设计，纳入2021年3月至2024年3月收治的96例单侧颈内动脉重度狭窄（≥70%）或闭塞患者，根据ASITN/SIR侧支评分分为良好代偿组（58例）与不良代偿组（38例）。通过TCD检测大脑中动脉血流动力学参数（PSV、EDV、MFV、PI、RI），结合DSA验证侧支循环状态，随访12个月评估预后。采用Logistic回归分析预后危险因素。结果：良好代偿组PSV(82.32±18.51 vs. 56.45±15.32 cm/s)、MFV(56.93±12.33 vs. 35.89±9.83 cm/s)显著高于不良代偿组，PI(0.64±0.15 vs. 0.82±0.21)、RI(0.43±0.08vs. 0.51±0.11)显著降低（均P<0.001）。TCD参数与ASITN/SIR分级呈强相关性（PSV:r=0.62;PI:r=-0.61，均P<0.001）。多因素分析显示，年龄≥65岁（OR=1.06）、高血压（OR=3.07）、PI≥1.00(OR=17.25)及PSV≤60 cm/s(OR=1.96)为预后不良的独立危险因素（均P<0.05）。结论：TCD多参数联合模型可量化评估侧支循环功能，其中PI≥1.00及PSV≤60 cm/s是预测不良预后的关键指标。TCD无创、动态监测的优势为颈动脉狭窄/闭塞患者的血流动力学分层管理及个体化干预提供了重要依据。更多还原

【Abstract】 Objective: To investigate the hemodynamic characteristics of intracranial collateral circulation assessed non-invasively by TCD and their correlation with clinical prognosis in patients with severe carotid stenosis or occlusion. Methods: A retrospective cohort study design was used to include 96 patients with severe stenosis(≥70%)or occlusion of the unilateral internal carotid artery admitted from March 2021 to March 2024, who were divided into a well-compensated group(58 patients) versus a poorly-compensated group(38 patients) based on the ASITN/SIR collateral branch score. Hemodynamic parameters(PSV, EDV, MFV, PI, RI) were measured using TCD, and collateral circulation status was validated by digital subtraction angiography(DSA). Prognosis was evaluated over a 12-month follow-up. Logistic regression was used to analyze risk factors for poor prognosis.Results: The good collateral group exhibited significantly higher PSV(82.32 ±18.51 vs. 56.45±15.32 cm/s) and MFV(56.93±12.33 vs. 35.89±9.83 cm/s), and significantly lower PI(0.64±0.15 vs. 0.82±0.21) and RI(0.43±0.08 vs. 0.51 ±0.11) compared to the poor collateral group(all P<0.001). TCD parameters showed strong correlations with ASITN/SIR grades(PSV: r=0.62; PI: r=-0.61, all P<0.001). Multivariate analysis identified age ≥65 years(OR=1.06), hypertension(OR=3.07), PI≥1.00(OR=17.25), and PSV≤60 cm/s(OR=1.96) as independent risk factors for poor prognosis(all P<0.05). Conclusion: The TCD multi-parameter model enables quantitative assessment of collateral circulation function, with PI≥1.00 and PSV≤60 cm/s serving as key predictors of adverse outcomes. The non-invasive and dynamic monitoring advantages of TCD provide critical insights for hemodynamic stratification and personalized intervention in patients with carotid stenosis or occlusion.更多还原