脳血管連続撮影法より見た脳血管障害

A STUDY ON THE CEREBRAL VASCULAR INSUFFICIENCIES BY MEANS OF CEREBRAL SERIO-ANGIOGRAPHY

I．緒言

　脳血管連続撮影法の利点は，脳の動脈相，静脈相などの多相撮影によつて，脳血管の形態を多相において観察できることのみでなく，各血管相における造影剤充満時期の時間的変化をみることによつて，脳循環動態を知り，各種脳循環障害時において，診断上有力な所見をみいだし得る点にある。

　脳循環に関する臨床的検査法には，今日代表的なものとして，ガス分析法があり（Kety and Schmidt, 1945, 1948），脳循環量を定量的に測定できる点が，この方法の最大の特長であるが，しかしこれによつて測定されるものは脳全体に関しての総括的な循環量であつて，これによつて障害の局在を明らかにすることはできない。また放射性同位原素を用いる方法は，循環障害の局在に関して概略の知見は得られるが，障害の種類およびその原因が，どの血管にあるかを明らかにすることはできない。

Examination of cerebral circulation in cerebral vascular insufficiencies are essential for exact recogl-nition of modified clinical manifestations. Cerebra serio-angioraphy may be an only method to estimate the disturbed circulation with relation of morpho-logical changes of cerebral vessels. Author have presented a certain significances of cerebral serio-angiography in some of vascular occlusive diseases and vascular sclerotic disorders.

(1) Differential diagnosis of complete and imcom-plete arterial occlusion on a mono-phasic arteriogram is often impossible, because the both conditions present similar picture on the film. On the serial angiograms however, if the occlusion is imcomplete, extraordinary delayed arterial circulation can be ob-served in capillary-venous phases of angiograms; there-fore, serial angiography might be an essential ex-amination for the detailed recognition of pathology of occlusive disorders.

(2) Regenerative collateral vascular structures are usually visualized only in a part on a mono-phasic arteriogram. However, the whole of the structures may be possibly demonstrated in serial angiograms. According to the information obtained from it, detailed confirmation of modified manifestations may be possible.

(3) On the serial angiograms, momentary spotted contrast remnant was found infrequently on the inner wall of major arteries (carotid trunk etc. ) of sclerotic patient; consequently it was considered that this finding might indicate the presence of sclerotic atheromatous changes in this portion of the vessel.