64层螺旋CT灌注成像和血管成像在急性缺血性脑卒中的应用

目的：探讨64层螺旋CT 灌注成像（CTP）、CT血管成像（CTA）在急性缺血性脑卒中的应用价值。方法对30例急性缺血性脑卒中患者,于发病12 h内行头CT平扫、CTP、CTA检查,分析平扫及灌注CT表现,计算灌注缺损区CBF、CBV、MTT各参数值,与对侧相应区灌注参数进行比较,重建颈段和脑内动脉CTA图像,并于发病2～7 d复查CT平扫。结果30例急性缺血性脑卒中患者,15例C T平扫未发现异常,14例可见腔隙梗死灶或软化灶,1例可见脑梗死早期低密度改变。10例C T P未见明显异常,20例C T P发现与临床症状相对应的大小不等的灌注减低区,18例可见不同范围缺血半暗带。CTA 显示12例未见明显异常,18例可见血管狭窄或闭塞。结论 CTP、CTA能够快速准确反映缺血部位及范围,显示缺血半暗带,判断闭塞血管,对早期诊断急性脑梗死和指导溶栓治疗具有重要价值。     

急性缺血性脑血管病76例多模式CT影像学分析

目的探讨76例急性缺血性脑血管病(AICVD)的多模式CT影像学特点。方法采用320排多层螺旋CT对76例AICVD(发病时间24h)患者急诊进行CT平扫(NCCT)+CT灌注成像(CTP)+CT血管成像(CTA)一站式扫描检查,分析灌注区脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)等灌注参数变化及CT血管成像(CTA),并于入院后3d内行头颅MRI,评估其脑灌注特点及血管影像。结果在获取的76例CTP数据中,通过感兴趣区识别划分筛查,有59例患者有明确的异常CTP,有17例患者未发现明确感兴趣区。59例异常CTP中包括急性脑梗死47例,短暂性脑缺血发作(TIA)12例。急性脑梗死患者异常CTP特点:发病在4.5h以内的4例患者CTP表现为患侧CBF均较健侧下降,CBV正常或者轻度增高,MTT、TTP延长;发病时间在4.5~6h内的4例:其中2例CTP表现为CBF降低,CBV正常,MTT、TTP延长,2例表现为CBF降低,CBV轻度降低,MTT、TTP延长;发病时间在6~24h内的39例:其中30例梗死区与CTP异常脑灌注区部位一致,均表现CBF明显降低,CBV明显降低,MTT、TTP延长;12例TIA患者CTP均发现与临床症状相对应的灌注异常:MTT、TTP延长,CBF正常或减低,CBV升高。CTA发现责任动脉重度狭窄5例,血管闭塞10例,7例可见血流缓慢,排空延迟及侧支血管形成。结论多模式CT能够对AICVD提供血流灌注参数的变化及血管情况、供血区的血流动力学变化,对临床诊治具有一定参考价值,主要用于评估大脑半球卒中,多模式CT有临床价值。     

急性脑梗死患者脑血管异常与CT灌注成像参数的关联性研究

目的：探讨急性脑梗死患者脑血管异常与 CT 灌注成像（CTP）参数的相关性及其对临床预后的影响。方法临床纳入发病6 h 内颈内动脉系统急性脑梗死患者45例,所有患者均接受 CT 平扫、CTP 及 CT 血管造影（CTA）,分析 CTP 各个参数并评估患侧大血管情况。以血管情况分为血管正常组（17例）、血管狭窄组（10例）和血管闭塞组（18例）。另外,发病时、发病14 d 、发病90 d 分别采用美国国立卫生研究院卒中量表（NIHSS）、Barthel 指数（BI）、改良 Rankin 量表（mRS）评估患者的临床神经功能缺损、日常生活能力以及预后功能残疾水平。结果 CTA 检查显示：血管大致正常者17例,大脑中动脉狭窄者6例,大脑中动脉闭塞者8例,颈内动脉狭窄者4 例,颈内动脉闭塞者10例。3组患者在缺血区脑血流（CBF）面积、脑血容量（CBV）面积、梗死区相对 CBF（rCBF）、梗死区相对 CBV（rCBV）、局部灌注达峰时间（TTP）面积方面比较差异有统计学意义（P ＜0．05）;其中血管闭塞组以上参数均差于血管正常组,血管狭窄组仅 CBF 面积高于正常组,血管狭窄组与血管闭塞组比较,CBF 面积、CBV 面积、TTP 面积均较小,差异均有统计学意义（P ＜0．05）。发病时,各组间患者仅 NIHSS 评分差异有统计学意义（P ＜0．05）,血管正常组 NIHSS 评分明显低于血管狭窄组及血管闭塞组（P ＜0．05）。发病后14 d 、90 d ,各组患者 NIHSS 、BI 、mRS 评分差异均有统计学意义（P ＜0．05）,血管正常组各项评分均明显优于血管闭塞组（P ＜0．05）。结论急性脑梗死患者病灶侧血管异常与 CTP 显示的缺血范围存在密切的联系,能够作为患者临床预后的一个客观指标。     

CT血管成像及灌注成像与前循环脑梗死

目的 探讨CT血管成像(CTA)联合CT灌注成像(CTP)在前循环脑梗死中的临床应用价值.方法 回顾性分析542例经头MRI DWI证实大脑半球有新发梗死灶的缺血性脑卒中患者资料,所有病例均具备头CTA及CTP检查,分析责任血管病变程度与病灶大小、病灶部位血流灌注异常情况的关系.结果 在本组病例中责任血管多见于大脑中动脉(58.6％),其次是颈内动脉颅外段(32.9％).不同的责任血管病变部位、狭窄程度及其支配区灌注异常情况,其梗死灶的大小均具有显著性差异(P分别为0.015、0.000和0.000),其中以大脑中动脉病变、血管闭塞或中重度以上的狭窄以及灌注程度低的病例梗死灶相对大(＞ 15mm).但仍有28例(12.6％)责任血管为重度狭窄或闭塞的患者表现为腔隙性脑梗死.此外,337例CTP异常患者中,86例(25.5％)存在低灌注区大于梗死灶.结论 本研究显示前循环脑梗死的责任血管多见于大脑中动脉.影像学显示的梗死灶的大小并不完全与血管病变程度一致.此外,约25％患者存在梗死面积与灌注降低不匹配现象.因此,对前循环脑梗死患者进行CTA联合CTP检查,对临床缺血性脑卒中的综合性评估和个体化治疗具有较重要的参考价值.     

RAPID软件在急性缺血性脑卒中患者中的应用

脑卒中是中国居民死亡的第一病因,其中急性缺血性脑卒中(AIS)约占70%,具有高致死率、致残率的特点。RAPID软件是一种基于灌注成像的自动化后处理软件包,可以通过分析CT灌注成像(CTP)数据,快速且准确地评估梗死核心体积、不匹配体积和侧支循环情况。目前RAPID软件主要应用于快速筛选可以从血管内治疗中获益的急性缺血性脑卒中患者并评价其临床预后,尚无研究探索RAPID软件参数与标准药物治疗患者的预后的相关性。RAPID软件的准确性一直以来是探讨的热点话题,而其在CTP后的应用是否具有可替代性也尚未有定论。本文就RAPID软件在临床的最新进展展开综述,旨在进一步拓宽RAPID软件在临床中的应用,以提高AIS患者预后。     

640层螺旋CT脑灌注成像与CT血管成像在超早期脑梗死中的应用

目的探讨东芝Aquilion ONE 640层CT脑灌注成像(CTP)与CT血管成像(CTA)在超早期脑梗死患者中的应用价值。方法我院2014-06—2015-12收治的28例超早期脑梗死患者,均在发病后6h内实施CT平扫、CTP与CTA检查,分析平扫及灌注CT表现,计算CTP的达峰时间(TTP)、脑血流量(CBF)、脑血容量(CBV)各参数值,并与对侧及半暗带周边相应区灌注参数相对比;重建颈段和脑内动脉CTA图像,采用图像后处理技术显示病变血管情况,对动脉狭窄程度进行分级评价。所有患者3~7d内行多层螺旋CT复查,评估CTP与CTA在超早期脑梗死诊断中的临床价值。结果 28例患者经头颅CT平扫发现,11例有可疑脑缺血区,其余17例未见明显异常。行CT脑血管灌注成像发现,患者感兴趣区内rCBF、rCBV、rTTP(病变侧与对照侧灌注参数的相对比值)明显改变,脑梗死区较边缘区TTP更高,CBF、CBV更低,差异均有统计学意义(P0.01);半暗带区CBF、TTP与对侧比较差异有统计学意义(P0.01),而CBV对比差异无统计学意义(P0.05)。CTA检查发现,10例患者大脑中动脉闭塞,7例大脑中动脉狭窄,11例一侧颈内动脉狭窄或闭塞。结论 CTP早期发现脑梗死患者脑组织中的缺血半暗带,CTA检查可准确判断狭窄或闭塞血管,在脑梗死患者的早期诊断和指导溶栓治疗中有重要临床价值。     

CT血管造影联合CT灌注在缺血性脑卒中的临床应用

目的探讨血管造影联合CT灌注在缺血性脑卒中的临床价值。方法选择2012-03—2014-03在我院诊治的缺血性脑卒中患者42例,采用东芝320排CT行头部CTA及CTP检查。观察两种检查方法对缺血性脑卒中的诊断情况,探讨颅内及颈部血管的狭窄与脑组织灌注异常区的关系。结果 CTP检查发现与临床症状相符的异常灌注区36例,感兴趣区的脑血容量及脑血流量较镜像区显著降低(P0.05);感兴趣区的平均通过时间显著延长(P0.05)。CTA检查发现颈部及颅内血管狭窄32例,10例未发现有血管狭窄。CTA有责任血管狭窄患者CTP阳性率(71.43%)显著高于CTA无责任血管狭窄者(14.29%)。结论缺血性脑卒中行CT血管造影联合CT灌注能准确反映脑组织血流动力学变化,有效判定颈部及颅内责任血管是否存在狭窄,为临床诊断提供依据。     

脑灌注CT成像评价静脉溶栓桥接动脉取栓后血流动力学变化与临床疗效的关系

目的利用CT灌注成像技术(CTP)评价比较静脉溶栓桥接动脉取栓治疗前后脑血流动力学变化及与临床疗效的关系。方法收集发病12h内急性脑梗死(ACI)患者行头颅MRI筛查,符合静脉溶栓标准且合并颅内大动脉闭塞或严重狭窄的患者73例,按照是否桥接动脉取栓治疗分为两组,A组为单纯静脉溶栓组,B组为静脉溶栓桥接动脉取栓组;术前及术后24h行头颅CTP检查;比较B组患者治疗前后血流灌注的变化,并比较A、B两组患者治疗后灌注各参数的变化及与疗效的关系。结果 B组治疗前后的相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对平均通过时间(rMTT)、相对达峰时间(rTTP)存在明显差异(P <0.05);A组与B组治疗后rCBF、rCBV、rMTT、rTTP存在明显差异(P <0.05);A、B两组患者血管再通率比较存在明显差异(P <0.05),症状改善率、转归良好率比较有明显差异(P <0.05)。结论静脉溶栓桥接动脉取栓能显著改善合并颅内大动脉闭塞或严重狭窄脑梗死患者脑血流动力学;CTP能够比较客观准确地评估血流再灌注程度,能够更全面、准确、客观地反映治疗的效果,并指导后续干预治疗。     

联合头颈部CTA与全脑CT灌注成像在慢性脑缺血患者中的应用价值

目的 通过对慢性脑缺血患者头颈部CTA 与全脑CT灌注（CTP）的相关性对比研究,评估 两种检查方法在慢性脑缺血患者中的应用价值。方法 对150 例患者行头颈CTA 和全脑CTP检查,对 灌注区域分布规律、责任血管与灌注异常区域的关系进行相关对比研究。结果 98.72% 灌注异常区域 其责任血管均为中度以上狭窄。随着责任血管狭窄程度的加重,灌注异常区域比例呈明显递增改变。 责任血管狭窄程度与CTP梗死前期分期呈中等正相关。 结论 结合头颈部CTA 与全脑CTP的结果,能 全面评判慢性脑缺血患者脑组织的慢性缺血程度,更有利于临床上的相关治疗方法的选择。     

腔隙性脑梗死102例患者的脑血流动力学分析

目的 依据神经影像学资料分析腔隙性脑梗死患者脑和血管病变及其发病机制。方法 对102例腔隙性脑梗死患者进行头颅MRI、CT血管造影（CTA）、CT灌注成像（CTP）检查。结果 单发腔隙性脑梗死3例，多发腔隙性脑梗死99例。CTA显示颈内动脉（ICA）重度狭窄或闭塞32例，轻-中度狭窄19例。中动脉（MCA）重度狭窄或闭塞11例，轻-中度狭窄5例。ICA或MCA粥样硬化23例，正常血管12例。CTP显示ICA-MCA供血区内血流灌注异常56例。结论 腔隙性脑梗死可能由大动脉狭窄或闭塞所造成的远端小动脉血流灌注减低和微栓子所致。     

Incidence of Unreliable Automated Computed Tomography Perfusion Maps

IntroductionDespite the increasing national adoption of automated computed tomography perfusion (CTP) to select thrombectomy patients 6 hours after last known well, reliability issues have been anecdotally reported. Unreliable diagnostic tests add time and confusion to a process that requires efficiency. Our study aims to critically assess an automated CTP program in a contemporary cohort of patients presenting with large vessel occlusion (LVO) in the extended time window by evaluating the rate of unreliable automated CTP maps and whether this influences clinical outcomes.MethodsA retrospective review of consecutive thrombectomy candidates undergoing CTP imaging in the extended time window was performed. All automated CTP maps using RAPID software (iSchemaView, Menlo Park, CA) were assessed for reliability. Clinical outcomes were compared between patients with and without reliable RAPID reports.ResultsNinety-nine consecutive thrombectomy candidates underwent automated CTP imaging from February 2017 to December 2018. Of these, 78 (79%) had LVO determined by CT angiographyand were included in the study population. Automated CTP maps were unreliable in 13% of cases as a result of motion artifact (n = 3) and contrast bolus flow issues (n = 7). Heart failure was more frequent in patients with unreliable studies. Clinical outcomes did not significantly differ between patients with and without unreliable studies.ConclusionsThirteen percent of CTP maps generated by automated software were unreliable, with an increased frequency among patients with heart failure. Given the rate of unreliable automated CTP maps, further studies are warranted to not only establish the true necessity of currently available CTP software, but also more reliable methods to select patients for thrombectomy presenting in the extended time window.     

头颅CT灌注成像在球囊闭塞试验中的辅助作用

目的探讨头颅CT灌注成像（CTP）在球囊闭塞试验（BOT）中的辅助判断作用。方法 20例经DSA确诊的颈内动脉巨大动脉瘤患者,临床判断为BOT阴性的同时行头颅CTP,通过比较双侧半球的脑血流量（CBF）、脑血容量（CBV）及达峰时间（TTP）对脑血流动力学进行评估。结果 20例患者均在BOT过程中完成CTP且无任何脑缺血症状,17例（85.0%）灌注对称,判断为耐受性良好,16例行永久性颈内动脉球囊闭塞术（其中4例联合动脉瘤部分栓塞术）,1例行颈内动脉慢性阻断术;3例（15.0%）灌注不对称,主要为阻断侧TTP延长,CBV正常或轻度升高,而CBF基本正常,即存在早期的脑血流动力学损害,认为其无法耐受颈内动脉的永久闭塞,其中2例行颅内外动脉搭桥联合动脉瘤孤立术,1例行支架辅助的动脉瘤致密栓塞术,载瘤动脉保留完整。所有患者随访15～32个月,均无远期缺血并发症。结论 CTP能检出BOT阴性者潜在的脑血流动力学损害,可以更客观地评估其对颈内动脉永久闭塞的耐受力,是BOT的重要补充。     

Identification of hemodynamically compromised regions by means of cerebral blood volume mapping utilizing computed tomography perfusion imaging

The aim of the study was to evaluate the potential role of computed tomography perfusion (CTP) imaging in identifying hemodynamically compromised regions in patients with occlusive cerebrovascular disease. Twelve patients diagnosed with either occlusion or severe stenosis of the internal carotid artery or the M1 portion of the middle cerebral artery underwent CTP imaging. The data was analyzed by an automated ROI-determining software. Patients were classified into two subgroups: an asymptomatic group consisting of three patients in whom perfusion pressure distal to the site of occlusion/stenosis (PP_dis) could be maintained in spite of the arterial occlusion/stenosis, and a symptomatic group consisting of nine patients in whom PP_dis could not be maintained enough to avoid watershed infarction. Four CTP-related parameters were independently compared between the two groups. Significant differences were determined using a two-sample t-test. When statistically significant differences were identified, cut-off points were calculated using ROC curves. Analysis revealed statistically significant differences between the asymptomatic and symptomatic subgroups only in the measure of relCBV (p = 0.028). Higher relCBV values were observed in the symptomatic subgroup. ROC curve analysis revealed 1.059 to be the optimal relCBV cut-off value for distinguishing between the asymptomatic and symptomatic subgroups. The data revealed that, in patients whose PP_dis is maintained, relCBV remains around 1.00. Conversely, in patients whose PP_dis decreased, relCBV increased. From these findings, we conclude that elevation of relCBV as observed using CTP imaging accurately reflects the extent of compensatory vasodilatation involvement and can identify hemodynamically compromised regions.     

大脑中动脉狭窄或闭塞显微手术治疗单中心经验并文献复习

目的 探讨颞浅动脉-大脑中动脉(STA-MCA)搭桥术治疗成人大脑中动脉狭窄或闭塞的疗效.方法 回顾性分析31例行STA-MCA搭桥术治疗的大脑中动脉狭窄或闭塞患者的临床资料,术前均行全脑血管造影(DSA)评价颈外动脉-颞浅动脉、颈内动脉、大脑中动脉的狭窄程度,CT灌注成像(CTP)评估脑血流灌注情况.手术采用经额颞入...     

基于CT灌注成像评估侧支循环在急性缺血性脑卒中取栓前后脑梗死进展及预后评估中的应用

目的探讨基于CT灌注成像(CTP)评估的侧支循环对急性前循环大动脉闭塞患者取栓前后脑梗死进展及临床预后的影响。方法回顾性分析浙江省人民医院神经内科自2018年5月至2019年9月收治的110例发病24 h以内的急性前循大动脉闭塞患者的资料。所有患者均完成取栓手术,采用区域性软脑膜侧支(rLMC)评分对四维CT血管造影(4D-CTA)上的全时相融合像(tMIP)进行侧支循环评估;根据CTP的核心脑梗死体积和术后1周内头颅MR的DWI影像结果,计算进展梗死体积;采用改良Rankin量表(mRS)评分评估患者术后3个月时预后情况。结果(1)侧支循环好组患者56例,侧支循环差组患者54例。年龄(OR=0.951,95%CI:0.910~0.993,P=0.023)、心功能不全(OR=0.116,95%CI:0.018~0.731,P=0.022)、基线空腹血糖(OR=0.788,95%CI:0.646~0.961,P=0.019)、觉醒性卒中(OR=0.093,95%CI:0.023~0.380,P=0.001)及颈内动脉段闭塞(OR=7.604,95%CI:2.650~21.821,P=0.000)是侧支循环的独立影响因素。(2)侧支循环评分(95%CI:-2.947~-1.474,P=0.000)、缺血半暗带体积(95%CI:0.065~0.126,P=0.000)、脑组织水肿评分(95%CI:2.952~7.600,P=0.000)、出血转化(95%CI:8.966~23.114,P=0.000)及24 h美国国立卫生研究院卒中量表(NIHSS)评分(95%CI:0.606~1.248,P=0.000)是进展梗死体积的独立影响因素。(3)预后良好组患者共59例,预后不良组患者共51例。出血转化(OR=0.019,95%CI:0.001~0.275,P=0.004)及进展梗死体积(OR=0.824,95%CI:0.756~0.897,P=0.000)是急性前循环大动脉闭塞取栓患者远期预后的独立影响因素。结论基于4D-CTA的rLMC侧支循环评分对发病24 h内急性前循环大动脉闭塞取栓患者的进展梗死体积有良好的预测作用,并可通过进展梗死体积进一步预测患者预后。     

Comparison of automated ASPECTS,large vessel occlusion detection and CTP analysis provided by Brainomix and RapidAI in patients with suspected ischaemic stroke

ObjectivesThe ischaemic core and penumbra volumes derived from CTP aid the selection of patients with an arterial occlusion for mechanical thrombectomy. Different post-processing software packages may give different CTP outputs, potentially causing variable patient selection for mechanical thrombectomy. The study aims were, firstly, to assess the correlation in CTP outputs from software packages provided by Brainomix and RapidAI. Secondly, the correlation between automated ASPECTS and neuroradiologist-derived ASPECTS and accuracy in detecting large vessel occlusion was assessed.Materials and MethodsThis retrospective study included patients undergoing CTP for suspected anterior circulation large vessel occlusion. Pearson's correlation coefficient was used for testing the correlation in CTP outputs, ASPECTS/automated ASPECTS, and—in those with complete or near complete occlusion—final infarct volume. Diagnostic statistics were calculated for large vessel occlusion detection.ResultsCorrelation was high for ischaemic core and penumbra volumes (0.862 and 0.832, respectively) but lower for the mismatch ratio (0.477). Agreement in mechanical thrombectomy eligibility was achieved in 85% of cases (46/54). Correlation between ischaemic core and final infarct volume was higher for Brainomix (0.757) than for RapidAI (0.595). The correlation between ASPECTS and automated ASPECTS (0.738 and 0.659) and the accuracy of detecting large vessel occlusion (77% and 71%) was higher for Brainomix than for RapidAI.ConclusionThere was high correlation between the CTP output from Brainomix and RapidAI. However, there was a difference in MT eligibility in 15% of cases, which highlights that the decision regarding MT should not be based on imaging parameters alone.     

多模式CT在评估急性缺血性卒中脑侧支循环中的应用

多模式计算机断层扫描（computed tomography,CT）包括CT平扫（non-contrast CT,NCCT）、 CT灌注成像（CT perfusion,CTP）、CT血管成像（CT angiography,CTA）,可以对急性缺血性卒中后侧支 循环进行全面评估,评估脑灌注状态,了解脑侧支循环建立或开放情况,判断临床预后,在急性缺血 性卒中的诊疗过程中发挥重要的作用。本文就多模式CT在缺血性卒中中的应用进行综述,以期使患 者获益更多。     

Brain CT perfusion improves intracranial vessel occlusion detection on CT angiography

Background and purpose

To evaluate whether brain CT perfusion (CTP) aids in the detection of intracranial vessel occlusion on CT angiography (CTA) in acute ischemic stroke.

Single-Centre Experience with Patients Selection for Mechanical Thrombectomy Based on Automated Computed Tomography Perfusion Analysis–A Comparison with Computed TomographyCT Perfusion Thrombectomy Trials

Background: In randomized clinical trials, mechanical thrombectomy (MT) was proved to be a highly effective treatment of acute ischemic stroke which improved clinical outcomes. Some of the trials used automated computed tomography perfusion (CTP) analysis for selection of participants. We present a single-center experience with CTP selection and comparison with CTP trials. Methods: Data of consecutive MT patients (from January 2016 to December 2017) were retrospectively reviewed. All patients with multiphase CT angiography confirmed the presence of anterior circulation large vessel occlusion/s in the intracranial internal carotid artery and/or middle cerebral artery (M1 or M2) and with admission brain CTP analyzed by RAPID software were included into the analysis. Results: Sixty-two patients fulfilled the inclusion criteria (mean age was 70.1 ± 13.6 years, females 48.5%). At baseline, National Institutes of Health Stroke Scale score was 16 (IQR?=?13-20), Alberta Stroke Program Early CT Score (ASPECTS) was 8 (IQR?=?7-9), CTP core volume was 20 mL (IQR?=?2-36), and CTP penumbra volume was 145.5 mL (IQR?=?107-184). Time from stroke onset to imaging was 1 hour 32 minutes, time from stroke onset to reperfusion was 3 hours 50 minutes, and median time from CT to reperfusion was 1 hour 56 minutes. Modified thrombolysis in cerebral infarction 2b/3 was achieved in 42 patients (67.7%). Twenty-three patients (37%) had modified Rankin scale 0-2 at 90 days. Conclusions: Our analysis of CTP-selected patients for MT supports clinical applicability of automated CTP analysis into everyday clinical practice.     

经颅多普勒超声评估单侧颈内动脉颅外段闭塞患者颅内侧支循环的临床意义

目的 探讨经颅多普勒超声(TCD)评估单侧颈内动脉颅外段闭塞(ICAO)患者颅内侧支循环的临床价值.方法 回顾性连续纳入2018年1月至2020年12月就诊于苏州大学附属第一医院卒中中心、行颈部血管超声检查为单侧ICAO及数字减影血管造影(DSA)证实患者145例,其中症状组109例,无症状组36例.记录TCD评估颅内...