脑侧支循环评估方法的研究进展 Advances in Cerebral Collateral Circulation Assessment Methods

侧支循环在急性缺血性卒中患者的预后评估中具有重要临床价值，其通过建立血流动力学代偿通路，可有效降低缺血核心区神经元损伤的风险，特别是在大血管狭窄或闭塞情况下发挥着不可替代的神经保护作用。精准的侧支循环评估不仅能够指导血管再通治疗的适应证选择、优化治疗时间窗的判定，还可以显著影响机械取栓治疗的成功率及术后过度灌注综合征的发生风险。基于单一参数的侧支循环评估模式具有局限性，最新循证医学证据支持构建多模态综合评估体系。本文系统综述侧支循环评估的四大方面，包括传统影像学评估方法、静脉流出动力学参数分析、生物标志物指标检测及人工智能辅助的多模态CT成像技术。这些评估手段的整合应用，为临床医师提供了多维度的侧支循环评价手段，为实现精准化、个体化的卒中救治提供了重要技术支撑。 Abstract: Collateral circulation holds significant clinical value in the prognostic evaluation of patients with acute ischemic stroke. By establishing hemodynamic compensatory pathways, it effectively reduces the risk of neuronal injury in ischemic core regions, especially demonstrating irreplaceable neuroprotective effects in cases of large vessel stenosis or occlusion. Precise assessment of collateral circulation can not only guide the selection of indications for revascularization therapy and optimize the determination of treatment time window but also significantly influence the procedural success rates of mechanical thrombectomy and the risks of postoperative cerebral hyperperfusion syndrome. Single-parameter assessment of the collateral circulation has limitations, and the latest evidence-based medical evidence supports the construction of a multimodal comprehensive assessment system. This paper systematically reviews four aspects of collateral circulation assessment, including conventional imaging assessment methods, venous outflow hemodynamic parameter analysis, biomarker detection, and artificial intelligence-assisted multimodal CT imaging techniques. The integrated application of these assessment methods provides clinicians with multidimensional means of assessing collateral circulation, offering crucial technical support for achieving precise and individualized stroke treatment.