超早期脑梗死的血管造影分析  

Angiographic findings in super-early period of ischemic stroke

作　　者：黄一宁[1] 金征宇[1] 徐蔚海[1] 张清[1] 叶健[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院神经内科

出　　处：《中华神经科杂志》2003年第4期252-255,共4页Chinese Journal of Neurology

摘　　要：目的 观察缺血性脑卒中超早期血管造影显示的血管狭窄或闭塞的比例及其分布。方法 观察对象为发病6h以内中度至重度的缺血性卒中,头颅CT排除出血,拟选择进行动脉内溶栓的患者。全部进行高选择性颈部和颅内血管造影。同步检查正侧位血管造影相和连续动态电影录像。必要时增加检查斜位相。使用血管直径和血管床灌注评分(TIMI)判断血管狭窄程度。分析血管狭窄部位、受累血管数目以及血管狭窄形态。结果 共收集了30例患者,平均57岁,其中男性23例。发病至血管造影时间(218±64)min。头颅CT显示陈旧脑梗死灶2例,可疑低密度9例,其余正常。血管造影显示87％患者有血管狭窄或者闭塞,其中20例(77％)为前循环受累,6例(23％)后循环受累;另外还发现10条无临床症状的血管狭窄或者闭塞。4例(13％)血管造影正常。大脑中动脉和颈内动脉受累最为常见。后循环受累的血管中以椎动脉最为常见。多部位和多血管受累达11例(37％)。高度狭窄的血管中需要高选择加压才显示血管残腔。1例患者同时有双侧后交通动脉起始部动脉瘤。结论脑梗死6 h内超早期血管造影显示大部分患者有肯定的脑血管狭窄或者闭塞。在选择治疗的方法和治疗途径上应该考虑不同的血管狭窄程度、部位和同时受累的血管数目。Objective To evaluate the frequency and localization of the involved arteries in ischemic stroke within 6 hours after onset. Methods The patients suffered from ischemic stroke with 5-30 points of NIHSS and cerebral hemorrhage should be excluded by CT scan. All subjects underwent high selective angiographies for the observation of aorta, carotid arteries, vertebral arteries, and all the intracranial arteries. The degree of stenosis, the localization and numbers of the arteries involved and the morphology of plaque or the stenosis were assessed. Results Thirty patients were enrolled with 23 males and a mean age of 57 years. The angiographies were performed with average time of (218 ±64) minutes after the onset of stroke symptom. The brain CT found old lesions in 2 cases and suspected hypodensitive lesions in 9. Angiography showed occlusive findings of cerebral arteries in 87% of the patients, among them 77% were located in anterior circulation and 23% in posterior. Additional 10 asymptomatic oclusive arteries were found. Angiograms were normal in 13%. The internal carotid arteries and middle cerebral arteries are most frequently involved in this series. The vertebral arteries were the most commonly involved in the posterior circulation. Only were the residual endings of occlusive arteries or the high grade of stenosis shown in high selective angiogram. The patients with the symptoms of posterior circulation were angiographied about 30 minutes later than the anteriorl ( (246. 6 ±87. 1) , (218. 9±65. 2) minutes,respectively). The aneurisms concurred in one case. Conclusion Most of patients with ischemic stroke with 6 hours were documented with definitive occlusion of cerebral arteries. The options of treatment should be based on the location, the number and the morphology of the involved arteries.

关 键 词：脑缺血 脑梗塞 脑血管造影术 头颅CT 溶栓治疗 血管狭窄 诊断标准 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R445[医药卫生—临床医学]