急诊血管内治疗CTA阴性大血管闭塞性急性脑梗死1例报告

A case of emergency endovascular treatment of CTA negative large vessel occlusion acute cerebral infarction

对于超静脉溶栓时间窗的重症大血管闭塞性急性脑梗死而言,急诊血管内治疗是首选的治疗措施。实施急诊血管内治疗的前提是在术前确认存在致病性大血管闭塞和值得挽救的缺血半暗带。CT血管成像(CTA)和磁共振血管成像(MRA)是目前常用的术前血管检查方法,可显示颅内大血管近端闭塞或狭窄,但对远段或分支显示有一定局限性。本文报告1例2019年在重庆医科大学附属永川医院神经内科接受急诊血管内治疗的CTA阴性的大血管闭塞性急性脑梗死患者。通过阐述其诊疗过程,探讨大血管闭塞性脑梗死的定义、CTA和常规二维数字减影血管造影(2D-DSA)诊断大脑中动脉M2段闭塞的局限性、临床表现和CT灌注成像(CTPI)识别大血管闭塞的重要意义以及三维数字减影血管造影(3D-DSA)在大脑中动脉M2段闭塞诊治中的应用价值,提高对M2段闭塞性急性脑梗死的诊治水平。

Emergency endovascular treatment is the preferred treatment for severe acute cerebral infarction with large vessel occlusion due to ultra venous thrombolytic time window.The preconditions for emergency endovascular treatment are preoperative confirmation of the presence of pathogenic large vessel occlusion and salvage ischemic penumbra.CT angiography(CTA)and magnetic resonance angiography(MRA)are commonly used preoperative vascular examination methods,which can show occlusion or stenosis at the proximal end of the large intracranial vessels,but have some limitations in the distal segment or branch.This paper report a case of CTA negative acute cerebral infarction with large vessel occlusion who received emergency endovascular treatment in the Department of Neurology,Yongchuan Hospital of Chongqing Medical University in 2019.Through the diagnosis and treatment process,probes into the definition of lange vascular occlusive cerebral infarction,CTA and conventional two-dimensional digital subtraction angiography(2D-DSA)in the diagnosis of the limitation of the middle cerebral artery occlusion of the M2,clinical manifestation and CT perfusion imaging(CTPI)to identify the significance of the arge vessels occlusion and three-dimensional digital subtraction angiography(3D-DSA)application in the diagnosis and treatment of middle cerebral artery occlusion of the M2 value,to improve the diagnosis and treatment of M2 segment occlusive acute cerebral infarction.