短暂性脑缺血发作DSA32例临床报告

目的:应用脑血管造影技术(DSA)对短暂性脑缺血发作(Transient ischemic attack,TIA)进行病因研究。方法:选择住院的TIA患者32例进行脑血管造影,12例进行了溶栓治疗,30例病人行颈动脉超声,观察TIA患者DSA结果,并与颈动脉超声结果比较。结果:1.TIA患者DSA显示颅内、外动脉异常,总异常率为93%(30/32);2.DSA显示颈内动脉颅外段异常78.1%(25/32),与颈动脉超声结果86.7%(28/30)较一致。结论:颅内外血管狭窄或闭塞可能是TIA的主要原因,对于TIA患者及早行DSA和颈动脉超声,进一步行介入及溶栓治疗,从而避免或减少脑血栓的发生。     

颈动脉系统TIA的血流动力学与发病机制初探

目的 探讨颈内动脉系统短暂性脑缺血发作（TIA）患者的血流动力学与发病的关系。方法 84例颈内动脉系统TIA患者均在末次发作后24h内进行经颅多谱勒（TCD）和血流动力学指数（CVDI）测定。结果 （1）TCD显示绝大多数患者脑动脉有严重狭窄或痉挛存在,从而引起脑血流速度的改变。（2）患者组与对照组CV-DI比较,零压顺应性（Co)明显下降,脑血管阻力（R）,特性阻抗（ZC）、脉搏波波速（WV）,动态阻力（DR）,临界压力（CP）增高,具有统计学意义,病灶侧与健侧比较,Co的下降及R、DR的增高具有统计学意义。结论 血流动力学的障碍是引起颈内动脉系统短暂性脑缺血发作的机制之一。     

脑梗死和后循环短暂性脑缺血发作患者颈总动脉内中膜厚度和血流动力学比较

目的探讨脑梗死和后循环短暂性脑缺血发作(TIA)患者颈动脉内中膜厚度和血流动力学的差异,明确颈动脉彩超在不同缺血性脑血管病的临床价值。方法对诊断明确的11例脑梗死组和17例后循环TIA组行颈动脉彩超检查,比较2组颈动脉内中膜厚度、收缩期血流峰值和椎动脉内径情况。结果脑梗死组颈总动脉内中膜厚度高于后循环TIA组,双侧颈内、外动脉及椎动脉收缩期峰值流速均高于后循环TIA组;所有患者左侧椎动脉内径大于右侧,但差异无统计学意义(P0.05)。结论血管彩超在脑梗死和后循环TIA评估中有重要价值,能体现动脉硬化程度和血流动力学差异。     

颈动脉系统短暂性脑缺血发作的数字减影全脑血管造影与血管内支架治疗53例临床分析

2003年4月～2004年11月,我们对53例颈动脉系统短暂性脑缺血发作(TIA)患者行数字减影全脑血管造影检查, 并根据临床症状和血管病变的程度行颈动脉支架置入手术 (CAS)治疗,报告如下。     

TlA和卒中患者的抗心脂质抗体研究

本文前瞻性研究了抗心脂质抗体(cardiolipin antibodies aCL)在TIA和卒中患者的流行情况。受试者均为成年患者,近期诊断(少于14天)为TIA或缺血性卒中。诊断依据病史、体检、头颅CT,必要时作颈动脉多普勒超声、心脏超声和脑血管造影检查。除外1,心脏瓣膜修补术或亚急性心内膜炎(SBE)患     

颈动脉系统短暂性脑缺血发作与颅内外动脉狭窄的相关性研究

目的探讨颈动脉系统短暂性脑缺血发作(TIA)与颅内外动脉狭窄的关系,评价数字减影血管造影(DSA)在颈动脉系统TIA中的诊断价值。方法对70例颈动脉系统TIA患者进行DSA检查,观察血管病变的性质,判断责任动脉。结果 70例患者中检出血管狭窄或闭塞59例(84.3%),其中症状相关侧血管狭窄或闭塞51例,症状相关侧对侧8例;颅内动脉狭窄发生率为86.9%(73/84),颅外动脉狭窄发生率为13.1%(11/84);56例(94.9%)可以判断责任动脉。结论颅内外动脉狭窄是颈动脉系统TIA的重要原因,DSA可以明确TIA患者血管狭窄的部位、程度、性质。     

彩色多普勒超声在脑血管病颈动脉粥样硬化诊断中的应用

目的总结脑血管病患者颈动脉粥样硬化的特点,观察彩色多普勒超声诊断颈动脉粥样硬化的价值。方法脑血管病患者210例(观察组),其中短暂性脑缺血发作(TIA)患者68例,动脉粥样硬化性梗死(AI)患者72例,腔隙性梗死(LI)患者70例,同期住院非脑血管病患者200例(对照组),应用彩色多普勒超声检测各组颈总动脉内-中膜厚度、动脉粥样硬化斑块数、斑块类型及斑块部位,并进行比较。结果 TIA、LI、AI患者单发及多发斑块发生率均高于对照组,差异有统计学意义(P0.05)。TIA、LI、AI患者软斑块、硬斑块发生率均高于对照组(P0.05),扁平斑块发生率低于对照组(P0.05)。观察组斑块多见于颈动脉分叉处,其次为颈内动脉起始处。结论 TIA、AI与颈动脉粥样硬化关系密切,及时多普勒超声检查有助于预测脑血管疾病分型。     

短暂性脑缺血发作与颅内外血管病变的观察

目的观察症状相关侧血管狭窄程度、颈动脉斑块与短暂性脑缺血发作(TIA)的相关性,及血管内介入治疗的可能性。方法应用DSA和颈动脉超声、经颅彩色多普勒超声(TCD)联合对62例急性期颈内动脉系统TIA患者进行检查。结果颈内动脉系统TIA患者的血管病变以颅内病变为主,以大脑中动脉病变最常见33例(51.6%),颈内动脉颅外段24例(37.5%),症状相关侧血管病变31例(48.4%),支架置入5例。结论颈内动脉系统TIA患者的病因与颅内外血管病变有关,其发病机制可能主要与血流动力学因素有关,介入治疗在TIA中的治疗价值有待进一步临床研究。     

颈动脉系统脑梗塞血液动力学分析

颈动脉系统脑梗塞血液动力学分析汪昕，范薇，朱文炳，丁光宏，覃开荣近年来，脑卒中病人的血液动力学（ＣｅｒｅｂｒａｌＨｅｍｏｄｙｎａｍｉｃｓ）研究倍受重视。有关脑血管局部血流量及血液速度已有较多研究［１～３］。而对脑血液动力学其它特征（如脑血管弹性、外周...     

椎基底动脉系统TIA患者的血液流变学改变

目的 探讨椎基底动脉系统短暂性脑缺血发作(TIA)患者的血液流变学改变及其临床意义。方法 对318例椎基底动脉系统TIA患者在末次发作后36h内进行血液流变学检查。结果 TIA组与对照组比较,全血粘度、红细胞压积、红细胞聚集性及纤维蛋白原等各项指标均无明显增高(P>0.05)。结论 椎基底动脉系统TIA的发病因素可能与血液流变学异常的关系意义不大。     

缺血性脑血管病患者颈动脉粥样硬化程度与循环内皮祖细胞的相关性分析

目的探讨缺血性脑血管病患者颈动脉粥样硬化程度与循环内皮祖细胞(EPCs)的相关性。方法根据CD133和KDR标记,采用流式细胞仪检测缺血性脑血管病患者(包括TIA、急性脑梗死、颈动脉粥样硬化)和健康体检者外周血内皮祖细胞(EPCs)数量变化。结果缺血性脑血管病患者EPCs数量较对照组明显减少(P<0.01);随着颈动脉粥样硬化程度加重,EPCs数量呈降低趋势,颈动脉重度狭窄与轻度和中度狭窄相比有差异(P<0.05);急性脑梗死和TIA患者较单纯颈动脉粥样硬化患者EPCs数量明显增加(P<0.01)。结论缺血性脑血管病患者EPCs与颈动脉粥样硬化程度呈负相关,可反映颈动脉粥样硬化的程度;急性缺血可能会增加EPCs的动员。     

尤瑞克林对急性脑梗死患者脑循环动力学的影响

目的 观察尤瑞克林治疗急性颈内动脉系统脑梗死患者的临床疗效及其对患侧脑循环动力学的影响。方法 急性单侧颈内动脉系统脑梗死患者78例,随机分为尤瑞克林治疗组和对照组。两组均给予抗血小板药物等常规治疗,治疗组另加用尤瑞克林治疗,疗程14d。在治疗前、后分别用美国国立卫生研究所脑卒中评分（National Institutes of Health Stroke Scale,NIHSS）评估两组患者的神经功能缺损程度,检测两组患者的脑循环动力学指标（cerebralvascular dynamics indexes,CVDI）,比较两组之间及治疗前后神经功能及脑循环动力学变化。结果 急性脑梗死患者经尤瑞克林治疗后神经功能恢复明显优于对照组,NIHSS评分、临床总有效率均显著改善（P<0.05）。两组患者治疗后患侧颈动脉最小血流速度、平均血流速度、最小血流量及平均血流量均较治疗前明显增加（P<0.05,P<0.01）,外周阻力均有所下降（P<0.01）;治疗组治疗后最小血流速度、平均血流速度、最小血流量及平均血流量的增加及外周阻力的下降均较对照组更明显（P<0.01）。治疗组治疗后的血管特性阻抗显著降低（P<0.01）。结论 尤瑞克林能改善急性脑梗死患者脑循环动力学指标,降低脑血管的阻力,增加脑动脉的供血量,促进神经功能恢复。     

前循环动脉粥样硬化性短暂性脑缺血 发作的血管病变及预后影响因素

目的 探讨首发前循环动脉粥样硬化性短暂性脑缺血发作(TIA)的血管病变及预后影响因素。方法 收集121例首发前循环动脉粥样硬化性TIA患者,发病48 h内入院,应用CT血管造影和颈动脉超声评估血管病变,采用ABCD评分,观察1年内脑血管病的发生率,比较血管病变及ABCD评分对预后的影响。结果(1)121例患者中106例共258支血管狭窄; 71例(58.68%)存在同侧颈部及颅内动脉狭窄≥50%,66例(54.55%)存在多支血管狭窄,33例(27.27%)有Willis 环变异; 66例(54.55%)检出不稳定斑块;(2)随访1年脑血管病发生率18.18%; 多元Logistic回归分析显示除了高血压病、高脂血症、发作时间≥10 min外,同侧颈部及颅内动脉≥50%狭窄(OR=2.65,95% CI:1.30～5.38,P=0.007)是影响预后的独立危险因素; 同侧颈部及颅内动脉狭窄分层后发现,同侧颈部及颅内动脉中度狭窄患者发生脑血管病的比例是正常或轻度狭窄5.92倍(95%CI:1.20～29.27,P=0.029),而重度狭窄或闭塞发生比例是正常或轻度狭窄7.92倍(95%CI:1.75～35.83,P=0.007);(3)与未发生脑血管病组比较,发生脑血管病组的ABCD2、ABCD3和ABCD3-V评分的得分均显著升高(P≤0.01); 3种评分法预测1年内发生脑血管病风险的ROC曲线下面积分别为0.68、0.73和0.80,ABCD3-V评分预测预后准确度最高(P<0.05),最佳界值为7.5分。结论 首发前循环动脉粥样硬化性TIA的血管病变广泛并严重,1年内脑血管病发生率高,同侧颈部及颅内动脉狭窄严重程度及ABCD3-V评分能更准确预测患者的预后。     

Cerebrovascular reactivity in carotid artery occlusion: possible implications for surgical management of selected groups of patients

OBJECTIVES: The aim of this study was to use transcranial Doppler ultrasonography to investigate cerebrovascular reactivity to hypercapnia in the middle cerebral arteries of patients with carotid occlusion with different outcomes. PATIENTS AND METHODS: Cerebrovascular reactivity to hypercapnia was calculated with the breath-holding index (BHI). Patients with unilateral carotid occlusion were divided as follows: asymptomatic (20 patients), transient ischemic attack (TIA) (20 patients), minor (20 patients) and major stroke (14 patients). Values of BHI homolateral to the carotid occlusion were compared with those of 25 healthy subjects and 34 stroke patients without significant carotid stenosis. RESULTS: BHI values were comparable in healthy controls, non stenotic stroke patients and asymptomatic occluded patients. BHI values of patients with symptomatic occlusion were significantly lower than those of the above-mentioned groups (P<0.0001). Moreover, the reduction of BHI was significantly associated with the extent of the neurological impairment. In fact, BHI values were significantly higher in TIA than in minor and major stroke (P<0.0001) and in minor than in major stroke patients (P<0.02). Finally, we found that a BHI value homolateral to carotid occlusion of 0.69 can be considered the cut-point for distinguishing between symptomatic and asymptomatic patients. CONCLUSION: Prospective studies are needed to demonstrate if the presence of this threshold value may help in selecting a subset of patients with asymptomatic carotid occlusion or with transient or mild neurological deficit with the highest probability of benefiting from surgical therapy.     

辛伐他汀对短暂性脑缺血发作患者颈动脉粥样硬化斑块的影响

目的探讨辛伐他汀对短暂性脑缺血发作（TIA）患者颈动脉粥样硬化斑块（AP）的影响。方法将86例明确伴有颈动脉AP的TIA患者随机分为研究组及对照组；研究组口服辛伐他汀及阿斯匹林肠溶片，对照组仅口服阿斯匹林肠溶片；于治疗前、治疗2及8个月后进行颈动脉超声检查，测颈动脉内-中膜厚度（IMT）、AP面积、数量，并观察治疗期间2组患者脑血管病的发生情况。结果与治疗前及对照组比较，研究组治疗8个月后颈动脉IMT变薄及AP面积、数量均明显减少，差异均有统计学意义（P〈0．05），但治疗2个月后上述指标与治疗前比较，差异均无统计学意义（P〉0．05）；治疗8个月后研究组脑血管病的发生率与对照组比较，差异无统计学意义（P〉0．05）。结论较长时间服用辛伐他汀能有效稳定TIA患者的颈动脉AP。     

Outcome of carotid artery occlusion is predicted by cerebrovascular reactivity

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the possibility of obtaining prognostic indications in patients with internal carotid occlusion on the basis of intracranial hemodynamic status, presence of previous symptoms of cerebrovascular failure, and baseline characteristics. METHODS: Cerebral hemodynamics were studied with transcranial Doppler ultrasonography. Cerebrovascular reactivity to apnea was calculated by means of the breath-holding index (BHI) in the middle cerebral arteries. Sixty-five patients with internal carotid artery occlusion were followed-up prospectively (median, 24 months), 23 patients were asymptomatic and 42 symptomatic (20 with transient ischemic attack and 22 with stroke). RESULTS: During the follow-up period, 11 symptomatic patients and 1 asymptomatic patient had another ischemic event ipsilateral to carotid occlusion. Among factors considered, only lower BHI values in the middle cerebral arteries ipsilateral to carotid occlusion and older age were significantly associated with the risk of developing symptoms (P=0.002 and P=0.003, respectively; Cox regression multivariate analysis). Based on our data, a cut point of the BHI value for distinguishing between pathological and normal cerebrovascular reactivity was determined to be 0.69. All patients except one, who developed TIA or stroke during the follow-up period, had BHI values ipsilateral to carotid occlusion of <0.69. CONCLUSIONS: These data suggest that impaired cerebrovascular reactivity is predictive for cerebral ischemic events in patients with carotid occlusion.     

瑞舒伐他汀钙对短暂性脑缺血发作患者血脂及颈动脉粥样硬化的影响

目的探讨瑞舒伐他汀钙对短暂性脑缺血发作(TIA)患者血脂及颈动脉粥样硬化的影响。方法 64例有颈动脉粥样硬化斑块的TIA患者随机分为治疗组(32例)和对照组(32例),两组在常规给予尼莫地平、阿司匹林、胞二磷胆碱等药物治疗的基础上,治疗组口服瑞舒伐他汀10 mg/d 6个月。检测治疗前后血脂水平;用彩色多普勒超声仪测量颈动脉内膜-中层厚度(IMT)、颈动脉粥样硬化斑块面积;随访6个月,记录脑血管病发生率及药物不良反应。结果治疗后治疗组血三酰甘油、胆固醇、低密度脂蛋白水平明显低于治疗前及对照组,颈动脉IMT、斑块面积明显小于治疗前及对照组(均P<0.05);对照组上述指标治疗前、后比较差异无统计学意义。治疗组随访期间脑血管病发生率(9.4%)明显低于对照组(37.5%)(χ2=7.108,P<0.05)。两组患者均未发现明显不良反应。结论瑞舒伐他汀钙可以有效降低血脂水平,改善颈动脉粥样硬化,降低脑血管病发生率。     

Distribution of artificial cerebral microemboli in stroke patients with patent foramen ovale

OBJECTIVES: Patent foramen ovale (PFO) is considered as an important risk factor for cerebrovascular diseases. Nevertheless, the relationship between the distribution of high-intensity transient signals (HITS), resulting from injection of air mixed with saline and detected by transcranial Doppler (TCD), and clinical cerebrovascular syndromes in these patients has not been investigated. METHODS: Using TCD, we screened 40 patients with stroke or transient ischemic attack (TIA), in whom PFO was proven by transesophageal echocariography (TEE). Of these, 30 patients (75%) with artificially produced HITS either in the middle cerebral artery (MCA) or the basilar artery (BA) were included in the analysis. RESULTS: Nineteen patients had a stroke or TIA in the carotid territory and 11 patients in the vertebro-basilar territory. HITS were found in the MCA in all 30 patients and in 21 of the 30 patients in the BA. Of the latter, ten patients were in the carotid group and 11 patients were in the veretebro-basilar group, p = 0.011. CONCLUSION: There is a significant association between the distribution of artificial HITS and the clinical cerebrovascular syndromes.     

ABCD~2评分结合经颅多普勒和颈部血管超声对TIA患者近期预后的评价

目的分析ABCD2评分结合经颅多普勒和颈部血管超声对短暂性脑缺血发作(TIA)后7 d发生脑梗死的评估价值。方法以2010年1月～2011年1月住院治疗的126例TIA患者作为研究对象,收集其临床、TCD和颈部血管超声检查资料。按ABCD2评分法进行评分,计算TIA后7 d内脑梗死发生率。结果 126例TIA患者7 d内进展为脑梗死者26例,占20.6%。ABCD2评分越高,脑梗死的发生率越高(P<0.05)。TIA后7 d脑供血动脉狭窄≥50%的患者中脑梗死发生率较脑供血动脉狭窄<50%的患者明显升高(P<0.05)。ABCD2评分≥4分、脑供血动脉狭窄≥50%的TIA患者7 d脑梗死发生率为33.8%,与ABCD2评分≥4分、脑供血动脉狭窄<50%的TIA患者(7.7%)比较,其发生脑梗死的风险明显增加(P<0.05)。结论 ABCD2评分法预测7 d发生脑梗死风险的准确性较高,进一步结合经颅多普勒和颈部血管超声检查可提高预测的准确性。