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认识引起一过性黑矇的栓子的来源,对于予防暂时性缺血的发作,脑梗塞或视网膜梗塞是重要的。粥样化栓子常起源于颅外颈动脉系统,通过颈内动脉至眼或脑。作者描写三个有一过性黑矇的病人,血管造影曾有颈外动脉疾病。这三个病人和文献的证据,支持栓子经颈外动脉侧枝至眼动脉分支视网膜中央动脉。例1:男性,58岁,心绞痛16年。右眼视力丧失反复发作,每次约10分钟之久。当一次黑矇发作时,右眼视网膜中央动脉及其邻近分支内可见一白色栓子。右颈动脉血管造影显示右颈内动脉闭塞。一周后,右颈外动脉及颈总动脉扎住及分离,暴露的动脉很脆,分支处部分被切除,将颈外及颈总动脉再吻合。切除的一段内有大的溃疡斑块,术后病人右眼失明。眼底镜显示弥漫性视网膜梗塞,动脉血流缓慢及有许多额外的栓子。
Understanding the source of the emboli that cause transient blindness is important in preventing the onset of transient ischemia, cerebral infarction or retinal infarction. Atherothrombosis often originates in the extracranial carotid system through the internal carotid artery to the eye or brain. The author describes three patients who had a transient amaurosis who had had an external carotid artery disease. The evidence of these three patients and the literature supports the embolization of the emboli through the lateral branches of the external carotid artery to the central retinal artery branch of the ophthalmic artery. Example 1: Male, 58 years old, angina for 16 years. Right eye loss of vision loss of recurrent, each about 10 minutes long. When a malady attack, the right eye central retinal artery and its adjacent branches can be seen a white embolus. Right carotid angiography showed right internal carotid artery occlusion. One week later, the right external carotid artery and common carotid artery were seized and separated. The exposed artery was very fragile. The branch was partially excised and the common carotid artery and common carotid artery were re-stapled. There is a large ulcer plaque in the resected section, and the patient’s right eye is blind after the operation. Fundus showed diffuse retinal infarction, slow arterial blood flow and many extra emboli.