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In this age when we are witnessing a veritable explosion in new
modalities in diagnos tic imaging we continue to have a great need
for detailed studies of the vascularity of the brain in patients
who have all types of cerebral vascular disease. Much of the
understanding of cerebral vascular occlusive lesions which we
developed in the last two decades was based on our ability to
demonstrate the vessels that were affected. Much experimental work
in animals had been done where major cerebral vessels were
obstructed and the effects of these obstructions on the brain
observed pathologically. However, it was not until cerebral
angiography could be performed with the detail that became possible
in the decades of the '60 's and subsequently that we could begin
to understand the relationship of the obstructed vessels observed
angiographically to the clinical findings. In addition, much
physiologic information was obtained. For instance, the concept
ofluxury perfusion which is used to describe non-nutritional flow
through the tissues was observed first angiographically although
the term was not used until LASSEN described it as a
pathophysiological phenomenon observed during cerebral blood flow
studies with radioactive isotopes. The concept of embolic
occlusions of the cerebral vessels as against thrombosis was
clarified and the relative frequency of thrombosis versus embolism
was better understood. The concept of collateral circulation of the
brain through so-called meningeal end-to end arterial anastomoses
was vastly better understood when serial angiography in obstructive
cerebral vascular disease was carried out with increasing
frequency."
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