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中华脑血管病杂志(电子版) ›› 2025, Vol. 19 ›› Issue (04) : 340 -346. doi: 10.3877/cma.j.issn.1673-9248.2025.04.012

病例报告

多发脑动脉狭窄介入术后脑过度灌注综合征一例及文献复习
王也1,2, 付伟1,2, 武剑1,2,()   
  1. 1 102218 北京,清华大学北京清华长庚医院神经内科 清华大学临床医学院
    2 100084 北京,清华大学/IDG-麦戈文脑科学研究所
  • 收稿日期:2025-02-11 出版日期:2025-08-01
  • 通信作者: 武剑

Cerebral hyperperfusion syndrome following endovascular treatment for multiple intracranial arterial stenosis: a case report and literature review

Ye Wang, Wei Fu, Jian Wu()   

  • Received:2025-02-11 Published:2025-08-01
  • Corresponding author: Jian Wu
引用本文:

王也, 付伟, 武剑. 多发脑动脉狭窄介入术后脑过度灌注综合征一例及文献复习[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(04): 340-346.

Ye Wang, Wei Fu, Jian Wu. Cerebral hyperperfusion syndrome following endovascular treatment for multiple intracranial arterial stenosis: a case report and literature review[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2025, 19(04): 340-346.

图1 术前患者的基线头CT及头磁共振成像-弥散加权成像(MRI-DWI)序列影像。图a为头CT,箭头示左侧胼胝体膝部低密度灶;图b为头CT,箭头示左侧脑室前角低密度灶;图c为头MRI-DWI序列,箭头所示左侧胼胝体膝部弥散高信号,提示新发梗死灶;图d为头MRI-DWI序列箭头所示胼胝体体部及左侧脑室前角弥散高信号,提示新发梗死灶;Alberta卒中项目早期CT评分为9分
图2 术前患者的头颅一站式磁共振血管成像-动脉自旋标记(MRA-ASL)序列影像。图a为MRA序列,红色箭头所示左侧大脑前动脉未显影;图b为术前患者的ASL序列,白色箭头所示右侧小脑及脑干区域脑血流量(CBF)对比左侧小脑灌注呈下降改变;图c为术前患者的ASL序列,白色箭头区域及周围蓝绿色所示右侧大脑半球CBF对比左侧半球灌注呈下降改变
图3 术中该患者的数字减影血管造影(DSA)影像。图a为右侧颈总动脉造影,圆圈内为右侧颈内动脉起始段重度狭窄,红色头所指右侧大脑前动脉及大脑中动脉显影浅淡,前交通动脉未开放;图b为左侧颈总动脉造影,圆圈内为左侧颈内动脉起始段重度狭窄,红色头所指左侧大脑前动脉A1段闭塞:图c为双侧椎-基底动脉造影,圆圈内为双侧椎动脉起始段重度狭窄,红色头所指右侧颈升动脉经肌支代偿部分右侧椎动脉颅内血流
图4 术后患者的数字减影血管造影影像。图a为左颈总动脉造影可见支架植入顺利,残余狭窄<30%,颅内远端血流改善,但左侧大脑前动脉A1仍未显示;图b为右侧锁骨下动脉-椎动脉造影,支架植入效果满意,狭窄解除;图c为左侧锁骨下动脉-椎动脉造影,支架植入效果满意,狭窄解除 注:LCCA为大动脉粥样硬化型
图5 术后该患者的复查CT及磁共振血管成像-动脉自旋标记(MRA-ASL)影像。图a为头CT示未见脑组织出血信号,陈旧缺血灶大致同术前;图b为术后ASL可见双侧后循环的脑血流量(CBF)对称增高,呈椎基底动脉系统过度灌注表现;图c为术后ASL可见白色箭头所示左侧半球CBF较对侧呈过度灌注表现
图6 患者分期行右侧颈动脉支架治疗数字减影血管造影影像。图a为正位的右侧前循环血管造影,对比术前及术后的大脑前对动脉,可见红色箭头所示前交通动脉开放,左侧额叶及胼胝体区血供改善;图b为侧位的右侧前循环血管造影,对比术前及术后可见极重度狭窄解除
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