Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA.
J Neuroimaging. 2011 Jul;21(3):266-8. doi: 10.1111/j.1552-6569.2010.00493.x. Epub 2011 Feb 18.
Despite current developments in neuroradiology, the sources of infarctions go undiagnosed in 28% of cases. An embolic source in the setting of minimal stenosis at the carotid bifurcation has rarely been reported. The authors report a previously healthy 48-year-old woman, without any risk factors for cerebrovascular events, sustained multiple cerebral infarctions in the right anterior and middle cerebral artery territory. Repeated imaging of the heart and cerebral vessels missed a very small abnormality arising from the posterior wall of the internal carotid artery, until it was diagnosed by computed tomographic angiography. This is problematic because by North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, minimal stenosis essentially excludes the carotid artery as an embolic source. Despite maximum antiplatelet and anticoagulation therapy, she continued to have neurological deteriortation by progression of her strokes. She underwent standard carotid endarterectomy and sustained no new embolic phenomena. Histopathological examination showed an endothelial hyperplasia with organizing thrombus, which on the posterior wall of the internal carotid artery, is likely a hemodynamically induced on top of preexisting atherosclerotic plaque.
尽管神经放射学领域目前取得了进展，但仍有 28%的病例无法确定梗死的原因。在颈动脉分叉处狭窄程度极小的情况下，栓塞源很少有报道。作者报告了一例以前健康的 48 岁女性，没有任何脑血管事件的危险因素，右侧大脑前动脉和大脑中动脉区域多处脑梗死。心脏和脑血管的反复成像都没有发现来自颈内动脉后壁的非常小的异常，直到计算机断层血管造影术才诊断出来。这是有问题的，因为根据北美症状性颈动脉内膜切除术试验（NASCET）标准，颈动脉狭窄基本排除了作为栓塞源的可能性。尽管进行了最大程度的抗血小板和抗凝治疗，她的中风仍在继续进展，导致神经功能恶化。她接受了标准的颈动脉内膜切除术，没有出现新的栓塞现象。组织病理学检查显示，颈内动脉后壁有内皮细胞增生伴机化血栓，这可能是在原有动脉粥样硬化斑块基础上，由血流动力学诱导的。
