短暂性脑缺血发作患者早期脑血管造影评价

Evaluation of early cerebral angiography in patients with transient ischemic attack

目的通过数字减影血管造影检查,分析短暂性脑缺血发作患者脑动脉狭窄程度和分布,探讨短暂性脑缺血发作与脑动脉狭窄的相关性。方法选择符合短暂性脑缺血发作诊断标准的患者101例,1周内行主动脉弓上造影及双侧颈总动脉、颈内动脉、锁骨下动脉和椎动脉造影,明确有无脑动脉狭窄、狭窄程度及分布。结果 101例患者中有82例137支血管狭窄。其中血管狭窄程度≥70%为70支,占51.1%,血管狭窄程度50%～69%为40支,占29.2%,血管狭窄程度<50%为27支,占19.7%;颅外段狭窄占46.7%,颅内段占53.3%,颅内、外病变血管比例为1.14:1;颅外段狭窄动脉中以颈内动脉颅外段最常见,占25.5%,而颅内段狭窄则以大脑中动脉最常见,占29.2%;颈内动脉系统短暂性脑缺血发作患者以大脑中动脉病变最常见,占40.2%,椎基底动脉系统短暂性脑缺血发作患者以椎动脉颅外段病变最常见,占28.0%。结论数字减影血管造影可以确定短暂性脑缺血发作患者是否存在血管狭窄及狭窄程度,对短暂性脑缺血发作治疗方案的选择起重要作用。

Objective To investigate the correlation between distribution of intracranial or extracranial arteriostenosis and transient ischemic attack（TIA）,and to analyze the distribution and degree of cerebral arteriostenosis in patients with TIA through digital subtraction angiography （DSA）. Methods 101 patients with TIA received DSA within one week after the last attack,to examine aortic arch, bilateral common carotid arteries, bilateral internal carotid arteries, bilateral subclavian arteries, and bilateral vertebral arteries, for diagnosis of cerebral artery stenosis and its degree. Results 137 arteries of 82 cases had cerebral artery stenosis,of which, 70 （51. 1%） had over 70% stenosis,40（29. 2%） had 50%-69%stenosis and 27（19.7%） had under 50% stenosis;46. 7% were extracranial arteriostenosis, mostly located in extracranial segment of ICA （25.5%） ,and 53.3% were intraeranial arteriostenosis,mostly located in MCA（29.2%）. Conclusion DSA can help to diagnose intracranial or extracranial arteriostenosis and its degree in the patients with TIA. It plays an important role in the choice of therapy for TIA.