근위 속목동맥협착증에 의한 뇌경색의 치료에 전산화단층 혈관조영술을 이용한 증례
Usefulness of CT Angiography in the Treatment of Ischemic Stroke Caused by Proximal Internal Carotid Artery Stenosis
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The influence of the atheroma composition of the proximal internal carotid artery (ICA) on stroke is not well reported compared to its stenosis degree or surface ulceration. A 66-year-old man was admitted for right hemiparesis. Magnetic resonance (MR) angiography revealed mild stenosis with smooth surface in left proximal ICA. He was anticoagulated due to suspicious thrombi in the left atrial appendage. Two years later, he was re-admitted for left middle cerebral artery (MCA) territory infarction despite adequate anticoagulation. In spite of stronger anticoagulation, another infarction occurred in the left MCA territory during admission. CT angiography (CTA) revealed fatty atheroma at proximal ICA. No further stroke occurred on antiplatelet agents instead of anticoagulation. Another man was diagnosed MCA infarction without obvious stroke etiology. CTA suggested fatty atheroma beneath smooth-surfaced mild proximal ICA stenosis, which led us to prescribe antiplatelets. Evaluation of plaque composition using CTA seems to be useful in the management of stroke caused by proximal ICA stenosis. (Korean J Stroke 2008;10:41-44)
Abstract
The influence of the atheroma composition of the proximal internal carotid artery (ICA) on stroke is not well reported compared to its stenosis degree or surface ulceration. A 66-year-old man was admitted for right hemiparesis. Magnetic resonance (MR) angiography revealed mild stenosis with smooth surface in left proximal ICA. He was anticoagulated due to suspicious thrombi in the left atrial appendage. Two years later, he was re-admitted for left middle cerebral artery (MCA) territory infarction despite adequate anticoagulation. In spite of stronger anticoagulation, another infarction occurred in the left MCA territory during admission. CT angiography (CTA) revealed fatty atheroma at proximal ICA. No further stroke occurred on antiplatelet agents instead of anticoagulation. Another man was diagnosed MCA infarction without obvious stroke etiology. CTA suggested fatty atheroma beneath smooth-surfaced mild proximal ICA stenosis, which led us to prescribe antiplatelets. Evaluation of plaque composition using CTA seems to be useful in the management of stroke caused by proximal ICA stenosis. (Korean J Stroke 2008;10:41-44)
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