Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Catheter Cardiovasc Interv. 2010 Mar 1;75(4):530-9. doi: 10.1002/ccd.22299.
Stroke is often the result of carotid atheroma, which may cause ischemia via progressive arterial narrowing or lead to superimposed thrombus formation and subsequent atheroembolism to the intracerebral vasculature. Revascularization through carotid endarterectomy or carotid artery stenting with embolic protection devices has produced favorable results in appropriately selected patients. In planning the percutaneous approach, an arch aortogram is first acquired to determine arch type and identify the presence of any anatomic variants which may affect the approach to the procedure and catheter selection. Subsequent imaging of the cerebral vasculature is performed to delineate the collateral circulation that is present, including an evaluation of the Circle of Willis. Although Doppler ultrasound, computed tomography (CT), and magnetic resonance angiography (MRA) may be useful in evaluating the presence of carotid or cerebrovascular disease, digital subtraction angiography is required prior to performance of a percutaneous intervention in order to create a procedural "roadmap". Additionally, the comprehensive management of cerebrovascular disease requires a detailed knowledge of the specific clinical syndromes that result from ischemia in each vascular territory. This methodical review of cerebrovascular anatomy and stroke syndromes will provide the operator with the tools to conduct a thorough neurological assessment prior to revascularization, evaluate any periprocedural complications that may arise, and evaluate the patient with suspected stroke.
中风通常是颈动脉粥样硬化的结果，其可能通过进行性动脉狭窄导致缺血，或导致继发血栓形成和随后的粥样栓子栓塞到颅内血管。通过颈动脉内膜切除术或带栓子保护装置的颈动脉支架置入术进行血运重建，已在适当选择的患者中取得了良好的效果。在规划经皮入路时，首先获取主动脉弓造影以确定弓的类型，并识别可能影响手术入路和导管选择的任何解剖变异。随后进行脑血管成像，以描绘存在的侧支循环，包括对Willis 环的评估。尽管多普勒超声、计算机断层扫描（CT）和磁共振血管造影（MRA）可能有助于评估颈动脉或脑血管疾病的存在，但在进行经皮介入之前需要进行数字减影血管造影，以便创建一个程序性“路线图”。此外，脑血管病的综合管理需要详细了解每个血管区域缺血引起的特定临床综合征。这种对脑血管解剖和中风综合征的系统回顾将为操作者提供在血管重建前进行彻底神经评估的工具，评估可能出现的任何围手术期并发症，并评估疑似中风的患者。
