摘要：

目的 总结颅内动脉开窗畸形致缺血性卒中的临床特点，并探讨缺血性卒中与颅内动脉开窗畸形的关系。方法与结果 共 11 例颅内动脉开窗畸形致缺血性卒中患者，头部 MRI 显示，梗死灶位于脑桥 5 例（5/11）、内囊后肢 3 例（3/11）、左侧丘脑 1 例（1/11）、左侧半卵圆中心 1 例（1/11）、双侧枕叶合并左侧颈内动脉动脉瘤 1 例（1/11）；头部 MRA 显示，开窗畸形发生于基底动脉 9 例（9/11）、左侧椎动脉1 例（1/11）、右侧大脑后动脉 1 例（1/11）；其中，5 例脑桥缺血性卒中系基底动脉（4 例）和右侧大脑后动脉（1 例）开窗畸形所致，3 例内囊后肢缺血性卒中均系基底动脉开窗畸形所致，1 例左侧丘脑缺血性卒中系左侧椎动脉开窗畸形所致，1 例左侧半卵圆中心缺血性卒中系基底动脉开窗畸形所致，1 例双侧枕叶缺血性卒中系基底动脉开窗畸形所致。均予抗血小板、调脂和清除自由基治疗，无一例缺血性卒中复发。结论 颅内动脉开窗畸形可以导致局部血流动力学改变，与缺血性卒中密切相关。

关键词: 卒中, 脑缺血, 血管畸形, 基底动脉

Abstract:

Objective To discuss the clinical features of ischemic stroke caused by intracranial artery fenestration, and to explore possible correlation between ischemic stroke and intracranial artery fenestration. Methods and Results We retrospectively studied 11 cases of ischemic stroke caused by intracranial artery fenestration from December 2012 to October 2017. Cranial MRI showed the infarcts were located in pons (5 cases, 5/11), posterior limb of internal capsule (3 cases, 3/11), left thalamus (one case, 1/11), left centrum semiovale (one case, 1/11) and bilateral occipital lobes combined with left internal carotid artery (ICA) aneurysm (one case, 1/11). MRA showed fenestration in basilar artery (BA) was found in 9 cases (9/11), fenestration in left vertebral artery (VA) was found in one case (1/11), fenestration in right posterior cerebral artery (PCA) was found in one case (1/11). Five cases of pontine infarction were caused by BA fenestration (4 cases) and right PCA fenestration (one case); 3 cases of internal capsule posterior limb infarction were caused by BA fenestration; one case of left thalamic infarction was caused by left VA fenestration; one case of left centrum semiovale infarction was caused by BA fenestration; one case of bilateral occipital lobes infarction was caused by BA fenestration. All patients were treated by antiplatelet aggregation, lipid regulation and scavenging free radical. No patient recurred ischemic stroke. Conclusions Intracranial artery fenestration may results in focal hemodynamic changes, and is closely related to ischemic stroke.

Key words: Stroke, Brain ischemia, Vascular malformations, Basilar artery