脑供血动脉狭窄的术前评估教学课件.pptVIP

* Figure 4. Images in a 49-year-old woman who was evaluated 6 hours after onset of right hemiparesis and dysphasia. (a) Left common carotid artery angiogram (lateral view) reveals an occlusion of the internal carotid artery beyond the carotid bulb. The abrupt occlusion distal to the carotid bulb and absence of atherosclerotic changes were haracteristic of an arterial dissection. (b) Right common carotid artery angiogram (lateral view) reveals irregularity of the cervical internal carotid artery (short arrows) and a pseudoaneurysm (long arrow) in the internal carotid artery. These findings are compatible with the diagnosis of fibromuscular dysplasia, which predisposes patients to spontaneous arterial dissection. Complete angiographic evaluation revealed occlusion of the internal carotid artery extending through the M1 segment of the MCA. Extensive leptomeningeal collateral blood supply to the MCA territory from the anterior and posterior cerebral arteries was present (not shown). Virtually complete thrombolysis was achieved 9 hours after symptom onset. (c) Left common carotid artery angiogram of the neck after thrombolysis helps confirm a dissection (arrow) of the internal carotid artery. (d) Left common carotid artery angiogram of the head shows excellent restoration of MCA patency after thrombolysis. The patient recovered well, with only very minor dysphasia and mild hand weakness persisting. * * * Stroke. 2001;32:1323-1329. A: Large lesion involving the cortex Territorial infarction 可能是ICA或MCA的闭塞，没有侧支循环 B: Subcortical lesion with or without additional smaller lesion(s); Subcortical infarction 可能是穿通支闭塞或MCA主干闭塞，但有皮层的侧支 C: Several disseminated small lesions，小血管被栓子或碎裂的血栓栓塞 D: Small lesions in hemodynamic risk zones; Border zone infarction:可能是大血管闭塞或严重狭窄导致的主要血管交界区及皮层和深部穿通血管交界区梗死 * Gillard JH, Hardingham CR, Kirkpatrick PJ, Antoun NM, Freer CE, Griffiths PD. Evaluation of carotid endarterectomy with sequential MR perfusion imaging: a preliminary report. AJNR Am J Neurora