Risk factors for occlusive lesions of intracranial arteries in stroke-free Japanese.

The aim of this study was to identify relevant risk factors for occlusive lesions of the intracranial arteries in stroke-free population. The subjects of this study were 425 patients without a history of stroke or transient ischemic attack and without any abnormality on a neurological examination who consecutively visited a neurology clinic between January 1994 and June 2001 requesting medical evaluation for possible cerebrovascular diseases. Subjects included 245 men and 180 women ranging in age from 33 to 89 years (mean+/-SD=64.0+/-10.0 years). We performed cervical and intracranial magnetic resonance angiography (MRA) in all subjects. Using a validated rating scheme of MRA for occlusive lesions, we evaluated the degree of stenoses in the extracranial portion of the internal carotid artery (ICA) and the intracranial arteries including the intracranial portion of the ICA, middle cerebral artery (MCA) stem, intracranial portion of the vertebral artery (VA), and basilar artery (BA). More than 25% stenoses were regarded as significant lesions in this study. Multiple logistic regression analyses showed that significant and independent predictors for extracranial ICA lesions were age, hyperlipidemia, and ischemic heart disease (IHD), those for intracranial ICA lesions were age, hypertension, diabetes mellitus, and IHD, those for MCA lesions were age and hypertension, those for intracranial VA lesions were hyperlipidemia and IHD, and those for BA lesions were hypertension and diabetes mellitus. The present study suggested that atherosclerosis of the intracranial VA was related to hyperlipidemia and IHD as was the case for the extracranial carotid artery, whilst atherosclerosis of other sites of intracranial arteries was associated with hypertension and diabetes mellitus in stroke-free Japanese.     

Combined extracranial and intracranial atherosclerosis in Korean patients

OBJECTIVES: To evaluate the frequency of intracranial atherosclerosis among patients with steno-occlusive extracranial carotid artery disease and to determine if there are factors related to the combined intracranial atherosclerosis. DESIGN: Cross-sectional study. SETTING: A tertiary referral hospital.Patients We studied 142 consecutive patients who had atherosclerotic steno-occlusive lesions (defined as > or =30% narrowing of the luminal diameter or occlusion) of an extracranial carotid artery confirmed by conventional angiography. We excluded patients who had potential cardiogenic sources of embolism. Potential vascular risk factors for each patient were obtained from medical records.Main Outcome Measure We determined the location and severity of atherosclerotic lesions by conventional angiography. We compared the vascular risk factors between patients with steno-occlusive extracranial carotid artery disease alone and patients with combined intracranial atherosclerosis and extracranial carotid artery disease. RESULTS: Intracranial steno-occlusive lesions (> or =30% stenosis or occlusion) were found in 80 patients (56.3%). Of 121 patients with significant (> or =50% stenosis or occlusion) extracranial carotid artery disease, 58 (47.9%) also had significant lesions of intracranial arteries. Univariate and multivariate analyses showed that diabetes mellitus was the only significant factor associated with combined intracranial atherosclerosis in patients with extracranial carotid artery disease. CONCLUSIONS: Intracranial atherosclerosis is common in Korean patients with steno-occlusive extracranial carotid artery disease. Diabetes mellitus is associated with intracranial atherosclerosis in patients who had steno-occlusive extracranial carotid artery disease.     

基底节区腔隙与非腔隙性脑梗死的颅内动脉造影及危险因素对比分析

目的:通过脑血管造影,分析基底节区腔隙与非腔隙性脑梗死患者的血管狭窄的比例与部位分布。方法:选择首次发病6小时内拟行动脉内溶栓治疗,并行脑磁共振(MRI)检查为基底节区脑梗死患者51例,依脑梗死的面积大小将患者分为腔隙梗死组(12例)和非腔隙梗死组(39例)。比较分析两组患者数字减影脑血管造影(DSA)结果及危险因素。结果:DSA结果显示:腔隙梗死组DSA检查未见明显异常9例,大脑中动脉(MCA)M1段狭窄2例(占16.7%),颈内动脉(ICA)颅外段狭窄1例(占8.3%)。非腔隙梗死组39例DSA检查均异常,共检出病变血管41支,血管病变部位为大脑中动脉M1段(53.6%)>颈内动脉颅内段(26.8%)>颈内动脉颅外段(17%)>大脑前动脉(2.4%)。非腔隙脑梗死组血管狭窄比例明显高于腔隙脑梗死组(p<0.05)。危险因素比较:腔隙和非腔隙脑梗死患者中患高血压比例均高于其它危险因素(91.7%,74.4%),但两组间比较无明显差异(p>0.05),比较两组间其它危险因素亦无明显差别(p>0.05)。结论:基底节区腔隙梗死患者DSA检查仅少数存在血管狭窄,多数无明确血管损害,梗死原因主要由小动脉病变引起;而非腔隙梗死患者绝大多数DSA有明确血管病变,大脑中动脉M1段是血管病变的主要部位。     

New England Medical Center Posterior Circulation Stroke Registry II. Vascular Lesions

Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, the extracranial (ECVA) and intracranial vertebral arteries (ICVA) were the commonest sites of severe occlusive disease followed by the basilar artery (BA). Severe occlusive lesions were found in >1 large artery in 148 patients; 134 had unilateral or bilateral severe disease at one arterial location. Single arterial site occlusive disease occurred most often in the ECVA (52 patients, 15 bilateral) followed by the ICVA (40 patients, 12 bilateral) and the BA (46 patients). Involvement of the ICVAs and the BA was very common and some patients also had ECVA lesions. Hypertension, smoking, and coronary and peripheral vascular disease were most prevalent in patients with extracranial disease while diabetes and hyperlipidemia were more common when occlusive lesions were only intracranial. Intra-arterial embolism was the most common mechanism of brain infarction in patients with ECVA and ICVA occlusive disease. ICVA occlusive lesions infrequently caused infarction limited to the proximal territory (medulla and posterior inferior cerebellum). BA lesions most often caused infarcts limited to the middle posterior circulation territory (pons and anterior inferior cerebellum). Posterior cerebral artery occlusive lesions were predominantly embolic. Penetrating artery disease caused mostly pontine and thalamic infarcts. Prognosis was poorest in patients with BA disease. The best prognosis surprisingly was in patients who had multiple arterial occlusive lesions; they often had position-sensitive transient ischemic attacks during months or years.     

小脑梗死的分型与后循环血管病变

目的 研究有无大血管病变患者小脑梗死灶的特征,探讨小脑梗死分型与后循环血管病变的关系。 方法 收集我科自2006年1月～2008年3月期间住院的小脑梗死患者共35例,所有患者均同时具备颅脑磁共振成像（magnetic resonance imaging,MRI）和血管造影检查,包括计算机断层摄影血管造影（computed tomographic angiography,CTA）、磁共振血管造影（magnetic resonance angiography,MRA）和数字减影血管造影（digital subtraction angiography,DSA）检查。根据血管造影检查的结果将入组患者分为两组：大血管病变组20例,小血管病变组15例,分析两组小脑梗死的分型和后循环血管病变（包括狭窄或闭塞）的关系。 结果 ⑴大血管病变组20例中,颅内血管（椎动脉颅内段或基底动脉）病变最多见（10例,50%）,梗死类型多为分水岭梗死（7例,70%）;其次为颅外血管合并颅内血管（椎动脉颅外段合并颅内段或基底动脉）病变（8例,40%）,梗死灶多为小脑后下动脉（PICA）供血区的区域性梗死（7例,87.5%）;单独颅外血管（椎动脉颅外段）病变最少见（2例,10%）,梗死分布无明显倾向性。⑵小血管病变组15例中,梗死灶亦多位于分水岭区（9例,60%）。 结论 由于小脑血液供应特点,小脑梗死中分水岭梗死和腔隙性梗死较区域性梗死更为常见。小梗死灶（直径≤2cm）可能存在后循环大血管的狭窄或闭塞,应予积极的治疗和干预,以防病情加重。     

Bilateral intracranial vertebral artery disease in the New England Medical Center, Posterior Circulation Registry.

BACKGROUND: Previous studies of patients with bilateral intracranial vertebral artery (ICVA) disease were selective and retrospective. METHODS: We studied risk factors, vascular lesions, symptoms, signs, and outcomes in patients with bilateral ICVA disease among 430 patients in the New England Medical Center Posterior Circulation Registry. RESULTS: Forty-two patients had bilateral ICVA occlusive disease (18 had bilateral stenosis; 16, unilateral occlusion and contralateral stenosis; and 8, bilateral occlusion). The most common risk factors were hypertension (32/42 [76%]) and hyperlipidemia (22/42 [52%]). Sixteen patients (38%) had transient ischemic attacks (TIAs) only; 18 (43%), TIAs before stroke. Occlusive vascular disease also involved the basilar artery in 29 patients (69%), the extracranial vertebral arteries in 18 (43%), and the internal carotid arteries in 11 (26%). Only 6 patients had no other major vascular lesion. Cerebellar symptoms were common. Among 30 patients with infarction, 21 (70%) had proximal intracranial territory involvement, and 15 (50%) had distal territory involvement. The location of occlusive lesions in relation to posterior inferior cerebellar artery origins did not significantly influence prognosis. During follow-up, 31 patients had no symptoms or slight disability, 2 had progression, and 7 died. Among 7 patients with poor outcome, 6 also had basilar artery stenosis or occlusion and 5 had proximal and distal intracranial territory infarcts. CONCLUSIONS: Most patients with bilateral ICVA occlusive disease have hypertension, other major occlusive lesions, and TIAs before stroke. Short- and long-term outcomes are usually favorable, but patients with bilateral ICVA and basilar artery-occlusive lesions often have poor outcomes.     

A clinicopathological analysis of 12 cases of cerebrovascular leptospirosis

12 pathologically verified cases of cerebrovascular leptospirosis were analysed of its clinical characteristics and types. Formation and development of cerebral panarteritis and infarctions were also discussed. It occurred in rural areas among children and adolescents after infection by leptospira pomona, especially following latent infection. Multiple occlusive vascular disorder presenting as a late manifestation of pomona infection occurred in 9 cases, intracranial hemorrhage in 2, and intracranial hypertension in 1 case. Cerebral panarteritis involved the main trunks of larger arteries at the base of the brain. Owing to invariable narrowing of intracranial portions of internal carotid arteries, infarcts always appeared in areas supplied by the middle cerebral artery, often accompanied by marginal infarction at watershed areas. It was suggested that cerebrovascular leptospirosis could be ascribed to residual infection of cerebral arteries soaked in CSF during the septicemic stage of pomona infection.     

Atherothrombotic cerebellar infarction: vascular lesion-MRI correlation of 31 cases.

BACKGROUND AND PURPOSE: Correlation of MRI findings with atherosclerotic vascular lesions has rarely been attempted in patients with cerebellar infarction. The aim of this study was to correlate the MRI lesions with the vascular lesions seen on conventional cerebral angiography in cerebellar infarction. METHODS: The subjects included 31 patients with cerebellar infarcts who underwent both MRI and conventional cerebral angiography. We analyzed the risk factors, clinical findings, imaging study, and angiography results. We attempted to correlate MRI lesions with the vascular lesions shown in the angiograms. RESULTS: The vascular lesions seen on angiograms were subdivided into 3 groups: large-artery disease (n=22), in situ branch artery disease (n=6), and no angiographic disease with hypertension (n=3). The proximal segment (V1) lesions of vertebral artery were the most common angiographic features in patients with large-artery disease in which stroke most commonly involved the posterior inferior cerebellar artery (PICA) cerebellum. The V1 lesions with coexistent occlusive lesions of the intracranial vertebral and basilar arteries were correlated with cerebellar infarcts, which had no predilection for certain cerebellar territory. The intracranial occlusive disease without V1 lesion was usually correlated with small cerebellar lesions in PICA and superior cerebellar artery (SCA) cerebellum. The subclavian artery or brachiocephalic trunk lesion was associated with small cerebellar infarcts. The in situ branch artery disease was correlated with the PICA cerebellum lesions, which were territorial or nonterritorial infarct. No angiographic disease with hypertension was associated with small-sized cerebellar infarcts within the SCA, anterior inferior cerebellar artery, or SCA cerebellum. CONCLUSIONS: Our study indicates that the topographic heterogeneity of cerebellar infarcts are correlated with diverse angiographic findings. The result that large-artery disease, in which nonterritorial infarcts are more common than territorial infarcts, is more prevalent than in situ branch artery disease or small-artery disease, suggest that even a small cerebellar infarct can be a clue to the presence of large-artery disease.     

人血浆CXC趋化因子配体16水平与颅内外动脉狭窄的关系

目的 探讨人血浆CXC趋化因子配体16（CXCL16）与颅内外动脉狭窄的关系。方法 2012年1月至2014年1月收治脑动脉狭窄致缺血性脑血管病患者100例,其颅内动脉狭窄54例,颅外动脉狭窄18例,颅内外动脉狭窄28例;轻度狭窄23例,中度狭窄35例,重度狭窄42例。另选择脑动脉正常健康体检者15例作为对照。酶联链免疫吸附法检测血浆CXCL16浓度。结果 与对照组CXCL16浓度[（1.15±0.11）ng/ml]比较,脑血管狭窄组血浆CXCLl6浓度[（3.25±0.24）ng/ml]显著升高（P<0.05）;单纯颅内动脉狭窄组、单纯颅外动脉狭窄组、颅内外动脉狭窄组比较,血浆CXCLl6浓度差异不具有统计学意义（P>0.05）;轻度脑动脉狭窄组、中度脑动脉狭窄组、重度脑动脉狭窄组CXCLl6浓度分别为[（3.02±0.11）ng/ml],[（3.17±0.07）ng/ml]和[（3.36±0.12）ng/ml],逐渐升高（P<0.05）,均明显高于对照组（P<0.05）。结论 人血浆CXCL16水平可能与脑血管狭窄有关,对脑动脉狭窄程度和脑血管事件的发生可能有一定的辅助预测作用。     

Evolving atherosclerosis at carotid and intracranial arteries in Japanese patients with ischemic heart disease: a 5-year longitudinal study with MR angiography

Progression of atherosclerosis at extracranial carotid and intracranial arteries in patients with ischemic heart disease (IHD) is not well defined. We carried out a 5-year longitudinal study with magnetic resonance angiography (MRA) of patients with IHD to assess the incidence of progression of atherosclerosis at extracranial carotid and intracranial arteries and to determine predictors of the progression. We previously performed carotid and intracranial MRA on 67 patients who had received selective coronary angiography for the clinical diagnosis of IHD. Of these 67 subjects, 41 patients gave informed consent to undergo MRA reexaminations to evaluate changes of extra- and intracranial arteries over a 5-year period. The degree of stenosis was divided into five grades depending on the narrowness of the arteries, i.e. normal, mild, moderate, severe and occluded. The average of follow-up period with MRA examination was 58.8 months. The progression of atherosclerosis, as defined as an increase of one grade of the stenosis rating, including both the exacerbation of pre-existing stenosis and the appearance of new stenotic lesions, were found in five patients (12.2%) for the cervical carotid artery and in only one patient (2.4%) for the intracranial artery. A multiple logistic regression analysis revealed that baseline carotid artery stenosis ( P  = 0.008), age ( P  = 0.047), and coronary events during the follow-up period ( P  = 0.048) were significant and independent predictors of progression of carotid atherosclerosis. In conclusion, our findings suggest that follow-up evaluation of the carotid artery is indicated for patients with IHD in whom carotid artery stenosis was detected on an initial examination. Further study is needed with larger numbers of patients to confirm these findings.     

Vasodilatory Responses and Magnetic Resonance Angiography

This study measured the responses of both extracranial (internal carotid arteries) and intracranial (middle cerebral/angular, basilar arteries) intravascular arterial volume flow rates to acetazolamide using phase-contrast magnetic resonance angiography. Twenty-eight newly studied patients were subdivided into four groups: Group I-Nonocclusive, asymptomatic (n = 7, or 14 carotid and middle cerebral/angular artery sides); Group II-unilateral carotid transient ischemic attacks, nonhemodynamic (embolic), varying stenoses (n = 11); Group III-unilateral carotid transient ischemic attacks, hemodynamic, varying stenoses (n = 5); and Group IV-unilateral carotid occlusion, asymptomatic (n = 5). The data were separated into nonischemic and ischemic sides so as to illustrate group differences based on vasodilatory responses to acetazolamide. For example, the percent change in volume flow rates over baseline values for the ischemic-side middle cerebral arteries of Group III was significantly the lowest of all of the vasodilatory responses (?25 ± 11% vs 40 ± 14% for group II ischemic middle cerebral/angular artery sides, p = 0.008). Group III patients also had significantly lower standing blood pressures (p = 0.012), higher number of transient ischemic attacks (p = 0.008), and shorter duration of events (p = 0.013). Determinations of volume flow rate continue to assist in determining the degree of hemodynamic compromise of a particular vascular territory.     

Ischaemic supratentorial stroke: angiographic findings in patients examined in the very early phase

Summary Eighty patients were studied by angiography within 6 h of an ischaemic stroke. Angiography was carried out with digital equipment and was usually limited to the vascular territory responsible for the neurological deficits. In 12 of 19 patients with internal carotid occlusion, the contralateral side was also studied. The angiographic abnormalities were classified as extracranial, intracranial, and combined extra and intracranial. The data show a high incidence (66%) of occlusive pathology of intracranial arteries, either isolated or associated with a significant presence of a potential embolic source (85%), and a high incidence of carotid occlusions located at the cervical segment (8 of 19). These observations suggest that most strokes are occlusive in origin.Presented at the First European Congress of Neurology, Prague, April 1988 and at the annual meeting of the American Society of Neuroradiology, Chicago, May 1988     

症状性颅内外血管不同狭窄程度微栓子 阳性率研究

【摘要】
目的 研究颅内外血管不同狭窄程度和闭塞时微栓子的阳性率差异。
方法 连续选取症状性颅内外血管狭窄并除外存在同侧颅内外血管串联狭窄的患者,按责任血管分
为颈内动脉狭窄、大脑中动脉狭窄和椎-基底动脉狭窄3组,按照责任血管的狭窄程度分为轻度、中度、
重度狭窄和闭塞组。所有患者行经颅多普勒超声（transcranial Doppler sonography,TCD）检测病变侧微
栓子,比较各组间微栓子阳性率的差异。
结果 研究期间共227例入组,颈内动脉狭窄组73例、大脑中动脉狭窄组126例、椎-基底动脉狭窄
组28例,3组的微栓子阳性率分别为34.25%（25/73）、38.89%（49/126）、39.29%（11/28）,无显著差
异。中度狭窄组及重度狭窄组的微栓子阳性率高于轻度狭窄组（P <0.001）及闭塞组（P <0.001）,轻度
狭窄组与闭塞组栓子阳性率无显著差异。
结论 中、重度颅内外血管狭窄者易发生微栓子的脱落,轻度狭窄组与血管闭塞组微栓子阳性率较低。     

Is Doppler ultrasound sufficient as the sole investigation before carotid endarterectomy?

BACKGROUND AND AIMS: Doppler ultrasound (DU) of the extracranial carotid arteries has been advocated as the sole imaging modality in carotid endarterectomy (CE) candidates. However this approach fails to identify patients with potentially significant intracranial disease, at high risk of stroke and death. Therefore, many stroke clinicians recommend angiography after screening DU. We aimed to identify the proportion of cases referred for CE in whom the identification of intracranial disease could have altered management. METHODS: Two neuroradiologists, blinded to the clinical history, reviewed the films of 111 CE candidates, predominantly of Caucasian background, who had undergone carotid angiography after screening DU. Intracranial stenoses >50% luminal diameter, incidental aneurysms and non-atherosclerotic lesions were documented. Demographic and epidemiological data were collected. RESULTS: Of the 111 patients, 87 had >50% extracranial stenoses although two thirds were asymptomatic. Intracranial stenotic lesions were recorded in 29% of patients. Over half of these were tandem lesions, distal to an extracranial stenosis. Aneurysms were found in 4.5% of patients. CONCLUSIONS: DU alone would have failed to detect significant intracranial disease in nearly a third of cases. These patients are at high risk of stroke. The identification of this group allows more aggressive stroke prevention therapy.     

Risk factors for atherosclerosis of cervicocerebral arteries: intracranial versus extracranial

OBJECTIVES: To search for factors determining the site of atherosclerosis of the cervicocerebral arteries in patients from Bangkok (Thailand) with ischemic stroke in the carotid territory. MATERIAL AND METHODS: Patients with the clinical syndrome of stroke or transient ischemic attack in the carotid territory or with ocular stroke were retrospectively studied. They were divided into an intracranial and an extracranial carotid stenosis group based on their vascular imaging. The stroke risk factors were then compared. RESULTS: There were 49 cases with extracranial carotid stenosis and 51 with intracranial stenosis. Among the patients with extracranial stenosis, 98% had associated intracranial disease, whereas none of those with intracranial stenosis had more than 50% of extracranial carotid stenosis. The presence of diabetes mellitus and a history of ischemic heart disease were found to be significantly more prevalent among patients with extracranial internal carotid artery stenosis. CONCLUSION: Diabetes mellitus as well as a history of ischemic heart disease were found to be more significantly prevalent in patients with combined extracranial internal carotid artery and intracranial stenosis. Extracranial carotid stenosis might represent a more severe atherosclerotic process of the cervicocerebral circulation when compared with intracranial stenosis.     

Brain arteriolosclerosis and hemodynamic disturbance may induce leukoaraiosis

OBJECTIVE: To investigate whether internal carotid artery (ICA) occlusive disease-induced hemodynamic disturbance is associated with extensive white matter high-intensity lesions (WMLs) on T2-weighted MR images in the hemisphere with lacunar infarct in the basal ganglia. BACKGROUND: Hemodynamic disturbance in the brain with arteriolosclerosis may be one of the mechanisms by which ischemic injury induces extensive WMLs. METHODS: The authors used MRI and PET to study 21 patients with unilateral ICA occlusion or stenosis and lacunar infarct in the bilateral basal ganglia. In hemispheres with ICA disease, the association of WMLs with the mean hemispheric values of oxygen extraction fraction (OEF)-an index of hemodynamic compromise-measured with the 15O-labeled gas steady-state technique was analyzed. Twenty-five patients with ICA occlusive disease without lacunar infarct were studied as control subjects. RESULTS: In the hemispheres with ICA disease, patients with lacunar infarct had a significantly greater severity of WMLs than control subjects, although the mean hemispheric values of the OEF showed no significant difference. The severity of WMLs correlated significantly with the mean hemispheric values of the OEF in patients with lacunar infarct, but not in control subjects. Multivariate analysis revealed that lacunar infarcts and increased OEF were independent predictors of extensive WMLs, with lacunar infarcts the most heavily weighted factor. CONCLUSION: Internal carotid artery occlusive disease-induced hemodynamic disturbance is associated with extensive WMLs in hemispheres with lacunar infarct. Hemodynamic disturbance may contribute to the development of extensive WMLs, although brain arteriolosclerosis may be a major contributing factor.     

中青年与老年脑梗死患者脑动脉狭窄分布的DSA分析

目的应用数字减影血管造影对中青年与老年脑梗死患者脑动脉狭窄的分布特征进行分析。方法选择脑梗死患者86例,根据患者年龄分为中青年组（年龄〈60岁）48例,老年组（年龄≥60岁）患者38例,应用数字减影血管造影技术（DSA）对患者脑动脉病变血管狭窄程度及分布进行分析。结果 1老年组患者在颅外动脉病变以及前循环狭窄发生率明显高于中青年组（P〈0.05）,而颅内动脉病变以及后循环狭窄发生率却明显低于中青年组（P〈0.05或P〈0.01）,在脑血管病变及颅内外动脉同时受累发生率上,两组差异无统计学意义（P〉0.05）;2中青年组最常见为重度狭窄,发生率高于轻度及中度狭窄（P〈0.05）,好发部位为椎动脉开口处,发生率高于颈内动脉起始段及大脑中动脉MI段（P〈0.05）;老年组最常见为重度狭窄（P〈0.05）,好发部位为椎动脉开口处及颈内动脉起始段,发生率高于大脑中动脉MI段（P〈0.05）。结论中青年患者最常受累血管为颅内血管,病变发生部位多以椎动脉起始处居多;老年患者最常受累血管为颅外血管,最常受累血管为椎动脉起始处及颈内动脉。     

Cerebrovascular complications of mucinous cancers

Six patients with mucinous cancer (2 colonic, 2 pancreatic, and 2 pulmonary origin) had necropsy evidence of thrombosis of large and small systemic, extracranial, and intracranial arteries and veins, and multiple cerebral infarcts and small hemorrhages. On microscopic examination, we found small infarcts and hemorrhages within the brain and mucin within vessels, macrophages, and in areas of infarction. The clinical picture included strokes and encephalopathy. Mucin-producing cancers can be associated with a coagulopathy that causes extensive occlusive vascular disease.     

Stroke risk factors and development of collateral flow in carotid occlusive disease

Background and purpose – Blood flow through collateral vessels compensates for reduced blood flow through stenotic or occluded extracranial carotid arteries. Previous studies have shown that extent of collateral flow influences likelihood of stroke and its outcome. Here we analyzed the relationship between stroke risk factors (hypertension, coronary artery disease, diabetes mellitus, tobacco smoking and hypercholesterolemia) and number of patent intracranial collaterals detected by transcranial Doppler ultrasonography. Subjects and methods – We studied 182 patients with various degrees of angiography proven unilateral stenosis of the internal carotid artery. Contribution of the anterior and posterior communicating arteries to the perfusion of the cerebral hemisphere on the side of the stenosis or occlusion was evaluated by a series of compression tests performed during continuous insonation of the middle cerebral artery. The number of detected collateral vessels was correlated with analyzed stroke risk factors. Results – Subjects with stenosis more than 75% or occlusion of the internal carotid artery had a higher frequency of two major intracranial collateral vessels ( P 0.01 and P 0.001, respectively). Hypertensive patients with stenosis more than 75% or total carotid occlusion were more likely to have only a single collateral vessel than patients without hypertension ( P 0.01 and P 0.05, respectively). Other risk factors did not influence the patency of preformed collateral vessels. Conclusions – Hypertension hindered the development of preformed intracranial collateral vessels in our patients with carotid occlusive disease.     

颅内复杂动脉瘤搭桥孤立术疗效观察

目的 探讨颅内外血管吻合或搭桥联合动脉瘤孤立术治疗颅内巨大型复杂动脉瘤的术式选择及适应证.方法 回顾分析2008年2月-201 1年12月经脑血管造影术明确诊断的12例颅内巨大型动脉瘤患者术前评价方法 及手术治疗经过.结果 12例患者中颈内动脉系统巨大型动脉瘤6例(4例位于颈内动脉海绵窦段或床突段、2例位于颈内动脉交通段),大脑中动脉巨大型动脉瘤3例,后循环动脉瘤3例.其中7例术前MR灌注成像显示载瘤动脉远端组织存在明显缺血.选择行颞浅动脉.大脑中动脉低流量血管吻合术;5例载瘤动脉远端组织供血正常,且搭桥血管长度较长(≥15 cm)、术前球囊闭塞试验呈阴性、患侧压颈脑血管造影侧支循环充盈不良患者,行高流量颅内外血管搭桥术.11例术后神经功能缺损程度评价良好,改良Rankin量表评分0-3分;1例术后4分,3个月后改善至3分.结论 对于无法施行塑形夹闭术的颅内复杂巨大型动脉瘤患者,颅内外血管吻合或搭桥联合动脉瘤孤立术是其可选择的最后方法 ;而MR或CT灌注成像观察载瘤动脉远端组织供血正常与否.是选择不同流量血管吻合或搭桥术的关键.枕动脉、颞浅动脉或桡动脉为常用搭桥血管.