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目的总结主动脉夹层致急性缺血性脑卒中的诊断及治疗经验。方法回顾性分析1例主动脉夹层致急性缺血性脑卒中患者的临床资料,并结合文献进行分析。结果本例患者以急性缺血性脑卒中症状起病,急诊头颅MRI弥撒加权成像检查示左侧枕叶、颞叶后部早期缺血性改变;急诊胸部CT平扫及CT血管造影检查示Stanford A型胸主动脉解离伴血栓形成,同时伴左侧颈动脉和左侧锁骨下动脉血栓形成。保守治疗1月后,行血管重建手术治疗,移植人工血管置换解离的升主动脉且与双侧腋动脉搭桥。术后颈部磁共振血管造影检查示左侧颈动脉和左侧锁骨下动脉再通;放射性碘苯丙胺单光子放射计算机断层扫描检查示局部灌注改善。结论主动脉夹层致急性缺血性脑卒中的临床诊断需仔细鉴别,为改善脑血流动力学,血管重建治疗是一种有效的方法。
Objective To summarize the diagnosis and treatment experience of acute ischemic stroke caused by aortic dissection. Methods The clinical data of 1 case of acute ischemic stroke patients with aortic dissection were retrospectively analyzed and analyzed with the literature. Results In this case, the onset of acute ischemic stroke symptoms, MRI findings of emergency head MRI weighted imaging revealed early ischemic changes of the left occipital lobe and temporal lobe; emergency chest CT scan and CT angiography showed Stanford A thoracic aortic dissection with thrombosis, accompanied by left carotid artery and left subclavian artery thrombosis. One month after conservative treatment, vascular reconstructive surgery was performed, grafts were dissected and the ascending aorta dissociated and dissociated to bypass the bilateral axillary artery. Postoperative neck magnetic resonance angiography showed the left carotid artery and the left subclavian artery recanalization; radioactive iodine Amphetamine single photon emission computed tomography examination showed improvement of local perfusion. Conclusion The clinical diagnosis of acute ischemic stroke caused by aortic dissection needs to be carefully identified. In order to improve cerebral hemodynamics, revascularization is an effective method.