众所周知，颅内动脉粥样硬化是国人最主要的脑缺血原因；认识其致脑卒中机制有助于深入理解该疾病的病理生理机制，进而指导制定诊治策略，判断预后。

现实中，对此类患者进行传统的解剖研究几乎是不可能的。然而，借助现代影像技术，通过分析急性梗死灶的分布模式特征，可间接推断颅内粥样硬化引发脑卒中的机制。相关文献报道中，通常应用DWI检测急性脑梗死病灶。

根据文献，颅内粥样硬化致脑卒中机制分类如下：

Kim Jong S, Nah Hyun-Wook, Park Sea Mi, Kim Su-Kyung, ChoKi Hyun. Risk factors and stroke mechanisms in atherosclerotic stroke: intracranial compared with extracranial and anterior compared with posterior circulation. Stroke. 2012;43:3313–3318.  https://doi.org/10.1161/STROKEAHA.112.658500

1、动脉-动脉栓塞：  DWI显示动脉狭窄病变以远供血区梗死灶；这些梗死灶一般多发、散在分布，通常与狭窄动脉供血区灌注障碍相关联（笔者注：血栓清除能力降低）。

Artery-to-artery embolism: DWI demonstrates infarcts distal to the stenosed vessel in the territory of the relevant artery in artery-to-artery embolism. They are usually multiple, scattered, and often associated with perfusion deficits throughout the territory of the stenosed vessel.

2、闭塞穿支动脉：梗死灶临近动脉狭窄病变，考虑是狭窄局部血栓形成闭塞了一条或多条穿支动脉开口。

Local branch occlusion: In local branch occlusion, infarcts are localized to an area adjacent to the stenosed vessel. This is attributable to the occlusion of the orifice of ≥1 perforators that supply the regions spansumably associated with local thrombus formation.

3、原位血栓闭塞：原位血栓闭塞相关梗死通常广泛累及狭窄动脉供血区的全部或大部分区域；然而，分水岭区常因侧支循环建立的缘故而得以幸免。

In situ thrombotic occlusion: In situ thrombo-occlusion involves infarcts that extensively involve the entire or most of the stenosed arterial territory. However, borderzone areas are frequently spared because of collaterals.

4、血流动力学障碍：血流动力学障碍相关梗死灶位于分水岭区（笔者以为是：内部分水岭区），一般呈线样分布，与管腔严重狭窄或闭塞下游灌注衰竭有关。

Hemodynamic impairment: With hemodynamic impairment, the infarcts are located in borderzone areas, usually are linear in shape, and are associated with perfusion deficits distal to the severely stenosed or occluded vessel.

5、多发机制：同时存在上述2个或2个以上致卒中机制。