颈动脉粥样硬化在进展性脑卒中的作用

目的　探讨颈动脉粥样硬化在进展性脑卒中的作用。方法　采用彩色多普勒超声对 6 8例进展性卒中和非进展性卒中患者的颈动脉进行检测 ,比较两组患者颈动脉粥样硬化的特征。结果　 6 8例进展性卒中患者颈动脉粥样硬化 5 8例 (85 3%) ,明显高于非进展性卒中组 (P <0 0 1)。而且中重度颈动脉粥样硬化、狭窄及斑块性质为软斑和溃疡斑的SIP组明显增高 ,两组比较有显著性差异 (P <0 0 1)。结论　颈动脉粥样硬化是进展性卒中的显著性危险因素之一 ,而中重度粥样硬化、狭窄以及不稳定斑块更容易导致进展性卒中的发生。     

进展性缺血性脑卒中与颈动脉粥样硬化的关系

目的 探讨进展性缺血性脑卒中与颈动脉粥样硬化的关系.方法 选取2010年6月～2010年12月入住吉林大学白求恩第一医院的进展性缺血性脑卒中患者50例(A组)及非进展性脑梗死患者50例(B组),用彩色多普勒超声对所有患者进行双侧颈总动脉及颈内动脉探查.结果 动脉斑块最易在颈总动脉分叉处形成,两组比较无显著差异,P＞0.05;A组颈动脉粥样硬化斑块中不稳定斑块多于B组,P＜0.05;A组患者中、重度颈动脉粥样硬化例数多于B组,P ＜0.05;A组患者中、重度颈动脉狭窄例数多于B组,P＜0.05.结论 进展性缺血性脑卒中与非进展性缺血性脑卒中颈动脉粥样硬化斑块都最易发生在颈总动脉分叉处;颈动脉粥样硬化不稳定斑块与进展性缺血性脑卒中关系密切,可能是导致脑梗死早期进展的重要危险因素;进展性缺血性脑卒中重度颈动脉粥样硬化及重度颈动脉狭窄明显高于非进展性脑梗死,也是发生进展性缺血性脑卒中的危险因素.     

颈动脉粥样硬化与缺血性进展性脑卒中的相关性研究

目的研究颈动脉粥样硬化在缺血性进展性脑卒中的作用.方法对30例进展性脑卒中和40例非进展性脑卒中患者的颈动脉用多普勒超声进行检测,比较2组患者颈动脉粥样硬化的特征.结果进展性脑卒中患者中23例有颈动脉粥样硬化(76.7%),明显高于非进展性脑卒中组(52.5%)(P＜0.05),且进展性脑卒中组中斑块性质为软斑和溃疡斑的比例明显高于非进展性脑卒中组,2组比较有显著性差异(P＜0.05).结论进展性脑卒中的发生与颈动脉粥样硬化密切相关,可作为预测及评价缺血性进展性脑卒中的重要指标之一.     

颈动脉粥样硬化与脑梗死复发的关系探讨

目的 探讨颈动脉粥样硬化的临床意义及与脑梗死复发的关系。方法 采用彩色多普勒超声对312例脑梗死患者的颈动脉进行检测，并随访12－18个月，比较脑梗死复发和无复发患者颈动脉粥样硬化的特征。结果 312例脑梗死患者在随访期有61例复发，动脉粥样硬化性血栓性脑梗死患者的复发率明显高于腔隙性脑梗死患者，且多为同侧复发；重度颈动脉粥样硬化57例，复发26例；重度颈动脉狭窄48例，复发25例；溃疡斑42例，复发23例，其复发率明显高于无颈动脉粥样硬化或伴轻度颈动脉粥样硬化的脑梗死患者。经Logistic回归分析发现，颈动脉粥样硬化的严重程度、狭窄程度以及溃疡斑与脑梗死的复发成正相关。结论 颈动脉粥样硬化与脑梗死的复发密切相关，颈动脉粥样硬化的严重程度是脑梗死复发的危险因素，可作为脑梗死复发的预测指标。     

缺血性脑卒中患者的颈动脉粥样硬化研究

目的 探讨缺血性脑卒中与颈动脉粥样硬化之间的关系，寻找颈动脉粥样硬化的主要危险因素及评价筛选颈动脉狭窄的方法。方法 对106例前循环急性缺血性脑卒中住院患者进行询问病史、检验血脂、体检颈动脉、应用彩色多谱勒超声检测颈动脉颅外段，必要时行全脑血管DSA检查。结果 缺血性脑卒中患者的颈动脉粥样硬化发生率明显增高；脑梗死组患者颈动脉硬化程度明显重于TIA组患者；颅外颈动脉狭窄≥50％有7例(6．6％)，有糖尿病、吸烟史及高LDL血症的患者颈动脉严重狭窄发生率明显增高；颈动脉狭窄率超过30％者多有血管杂音；颅外段颈动脉超声检查与DSA检查结果基本一致。结论 颈动脉粥样硬化是缺血性脑卒中的重要危险因素，糖尿病、吸烟史及高LDL血症是颅外段颈动脉粥样硬化的危险因素；可通过对高危人群体检颈动脉作初步筛选，再应用彩色多谱勒超声检测颈动脉，确定颈动脉粥样硬化情况及狭窄程度，为缺血性脑卒中的防治提供客观依据。     

进展性脑卒中的多因素分析

目的探讨高血压、糖尿病、颈动脉硬化斑块与进展性脑卒中的相互关系。方法回顾性分析48例进展性卒中患者临床资料，对其血压、血糖、血脂及病变的严重程度进行相关分析。结果48例进展性脑卒中伴高血压者43例，其中35例收缩压〈150mmHg（20kPa），舒张压〉90mmHg（12kPa），脉压〉30mmHg（4kPa），明显高于对照组（P〈0．01）；合并糖尿病者30例，明显高于对照组15例（P〈0．01）。颈动脉超声检查发现颈动脉硬化斑块者43例，其中软斑21例，溃疡斑21例，硬斑1例。结论高血压、糖尿病及动脉硬化斑块与进展性脑卒中的发生发展密切相关，这些危险因素的研究对防治进展性脑卒中有重要临床意义。     

进展性缺血性脑卒中相关危险因素分析

目的探讨进展性缺血性脑卒中发病的相关危险因素,为其预防和治疗提供依据。方法选取2011-06—2013-05我院收治的进展性缺血性脑卒中85例,非进展性缺血性脑卒中98例;通过查阅患者病历、进行问卷调查和血清学检测,分析进展性缺血性脑卒中发病的危险因素。结果 2组患者的糖尿病史、高血压史、高血脂史、伴颈动脉粥样硬化比例有显著差异(P0.05),2组患者的空腹血糖、白细胞、血清胆固醇、高密度脂蛋白、低密度脂蛋白、甘油三脂、纤维蛋白原也具有显著性差异(P0.05)。结论糖尿病史、高血压史、高血脂史伴颈动脉粥样硬化的患者是进展性缺血性脑卒中发病的高危人群,高血糖、高白细胞、高胆固醇、低高密度脂蛋白、高低密度脂蛋白、高甘油三酯、高纤维蛋白原是进展性缺血性脑卒中的危险因素。     

缺血性脑血管病与颈动脉粥样硬化的关系

目的 探讨颈动脉粥样硬化与缺血性脑血管病的关系。方法 以2001年6月至2004年12月在我院住院的1583例急性缺血性脑血管病患者为研究对象，应用超声诊断仪检测双侧颈动脉，采用非条件Logistic回归分析颈动脉粥样硬化的危险因素及与缺血性脑血管病的关系。结果 86．5％（1369／1583）患者存在不同程度颈动脉粥样硬化；脑梗死组颈动脉粥样硬化患病率（1087／1266，85．9％）较短暂性脑缺血发作组（198／317，62．5％）高。颈动脉粥样硬化病变特点以斑块居多（1286／1583，81．2％），而中重度狭窄发生率较低（214／1583，13．5％）；颈动脉斑块以颈总动脉分叉处最多见（665／1286，51．7％）。斑块发生率及颅外段颈动脉狭窄程度与脑血管病危险因素有明显相关性。结论 佛山地区缺血性脑血管病患者颈动脉粥样硬化病变可能以斑块居多，颈动脉粥样硬化与缺血性脑血管病有关。     

颈动脉粥样硬化与进展性缺血性脑卒中的关系

正随着人们生活水平的提升与生活节奏的加快,缺血性脑卒中患者发病年龄有所提前,且发病率逐年升高,特别是进展性缺血性脑卒中,预后较差,致残率与病死率均较高,严重威胁人们的身体健康与生命安全,给患者及家庭带来负担,受到国内外临床医生高度重视[1]。颈动脉粥样硬化是缺血性脑卒中的重要及危险因素,与脑梗死的发生及发展、复发有十分密切的关系[2-3]。本文选取我院102例进展性缺血性脑卒中患者与102例非进展性缺血性脑卒中患者进行动脉     

颈动脉粥样硬化与脑梗死关系的临床研究

目的研究颈动脉粥样硬化与脑梗死的关系。方法对116例经CT、MRI证实的脑梗死患者的颈动脉颅外段进行彩色超声多普勒检查，观察颈动脉壁的病变性质和颈动脉管腔的狭窄率，并与对照组进行比较。结果116例脑梗死患者中有85例（73．28％）颈动脉颅外段存在不同程度的粥样硬化斑，与对照组比较差异有显著性（P〈0.01）；粥样硬化斑块好发于颈总动脉分叉处（BIF），其次为颈总动脉（CCA）；梗死灶同侧颈动脉粥样硬化较对侧严重。结论颈动脉粥样硬化是脑梗死的重要危险因素，防止颈动脉粥样硬化斑块形成对预防脑梗死的发生有非常重要的意义。     

缺血性脑卒中患者动脉粥样硬化分布的临床研究

目的探讨急性缺血性脑卒中不同亚型与颈动脉粥样硬化分布的相关性。方法通过经颅多普勒超声(TCD)和颈动脉彩色多普勒血流成像(CDFI)方法检测颅内、外动脉粥样硬化程度,并结合病史、生化指标及影像学提示的病变部位进行综合分析。结果411例急性缺血性脑卒中患者,颅内动脉狭窄率为38.93%(160/411),颈动脉颅外段狭窄率24.09%(99/411)。颈动脉颅外段狭窄者年龄大、吸烟比例高,与无狭窄者比较差异有统计学意义(P=0.020,0.013);而颅内动脉狭窄者糖尿病发病率明显高于无狭窄者(P=0.005)。411例中皮质梗死49例、皮质下梗死108例、腔隙性梗死72例和短暂性脑缺血发作30例,颈动脉颅外段狭窄者以皮质梗死为主(P=0.001),并且动脉内-中膜层厚度明显增加(P=0.020);而颅内动脉狭窄者以腔隙性梗死更多见(P=0.016)。颅内、外动脉狭窄者的年龄、性别、血糖及血脂之间差异无统计学意义(均P>0.05)。结论临床和影像学检查所确定的急性缺血性脑卒中亚型与颅内、外动脉粥样硬化的病变部位相关,提示发病的原因可能不同。糖尿病与吸烟是引起颅内、外动脉病变的重要原因。     

不同部位缺血性脑卒中患者颈动脉超声特点的研究

目的探讨不同亚型的缺血性脑卒中患者的颅外段颈动脉硬化病变的发生状况及病变程度，为缺血性脑卒中的防治提供依据。方法收集急性缺血性脑卒中患者351例，按头颅CT或MRI结果分为皮质型（CI）、皮质下型（SCI）、椎基底动脉型（VBI）3个亚型，同时应用彩色多普勒超声对颅外段颈动脉病变进行量化评估，分析各型之间不同颅外段颈动脉病变的发生状况及病变程度的差异。结果皮质型脑梗死颈动脉狭窄发生率为75．9％，高于其他组，且差异显著（P〈0．05），皮质型脑梗死颈动脉狭窄〉50％者为25．3％，高于其他组，且差异显著（P〈0．05）。结论在缺血性脑卒中各亚型之间颅外段颈动脉硬化病变的发生状况及病变程度存在差异，其中以CI的病变最明显，其次为VBCI，SCI最低。     

Natural history of asymptomatic carotid artery stenosis

The prevalence of carotid artery stenosis 50% or greater increases from about 1% in people aged 50 to 59 to about 10% in people older than 70. Although carotid stenosis accounts for about 10% of ischemic strokes, only a minority of patients with carotid stenosis will have a stroke. The annual risk of ipsilateral ischemic stroke is relatively low, ranging from 1.0 to 3.8% and is about half of that of any stroke. There is a relatively weak relationship between carotid stenosis severity and risk of ipsilateral stroke. In addition to stenosis severity, carotid plaque composition, which can be evaluated by several noninvasive imaging methods, may be an independent risk factor for stroke. There are few data supporting the use of hemodynamic impairment assessment to predict stroke risk. Nonstroke vascular events are about twice as likely in patients with carotid bruits compared with those without. Patients with asymptomatic carotid stenosis have a particularly high risk of cardiac events (about 3.5% per year). Therefore, the most important part of the management of patients with carotid stenosis is optimization of medical therapy. Much remains to be done to identify patients at particularly high risk of ipsilateral stroke, for whom carotid endarterectomy may be necessary in addition to medical therapy.     

Interrelation between plaque surface morphology and degree of stenosis on carotid angiograms and the risk of ischemic stroke in patients with symptomatic carotid stenosis. On behalf of the European Carotid Surgery Trialists' Collaborative Group

BACKGROUND AND PURPOSE: The risk of ischemic stroke distal to an atherothrombotic carotid stenosis increases with the degree of stenosis. The main mechanism of stroke is thought to be embolism from fissured or ruptured plaque, but there are few published data on the relationship between plaque morphology and severity of stenosis and their independent effects on the risk of ischemic stroke. We sought to determine the interrelation between plaque surface morphology, degree of carotid stenosis, and the risk of ipsilateral ischemic stroke. METHODS: Severity of stenosis and plaque surface morphology were assessed on angiograms of the symptomatic carotid artery in 3007 patients in the European Carotid Surgery Trial and were related to baseline clinical characteristics, pathological characteristics of plaques examined at endarterectomy, and the risks of carotid territory ipsilateral ischemic stroke and other vascular events on follow-up. RESULTS: The early risk of ipsilateral ischemic stroke on medical treatment was closely related to the degree of carotid stenosis. However, the initial degree of carotid stenosis was not predictive of strokes occurring >2 years after randomization. Angiographic plaque surface irregularity and plaque surface thrombus at endarterectomy increased in frequency as the degree of stenosis increased (both P<0.0001). However, the degree of stenosis was still predictive of the 2-year risk of stroke on medical treatment after correction for plaque surface irregularity. Angiographic plaque surface irregularity was an independent predictor of ipsilateral ischemic stroke on medical treatment at all degrees of stenosis (hazard ratio=1.80; 95% CI, 1. 14 to 2.83; P=0.01). This relationship was maintained when the analysis was confined to strokes occurring >2 years after randomization (hazard ratio=2.75; 95% CI, 1.30 to 5.80; P=0.01). Neither the degree of stenosis nor plaque surface irregularity was predictive of the "background" stroke risk after endarterectomy or the risk of nonstroke vascular events. CONCLUSIONS: Angiographic plaque surface irregularity is associated with an increased risk of ipsilateral ischemic stroke on medical treatment at all degrees of stenosis. The increase in stroke risk with degree of stenosis is partly accounted for by the parallel increase in plaque surface irregularity and thrombus formation, but the degree of narrowing of the vessel lumen is still an independent predictor of ischemic stroke within 2 years of presentation.     

Die instabile Karotisstenose – eine entzündliche Erkrankung?

Arterioarterial thromboembolism from extracranial internal carotid artery (ICA) stenosis is an important pathogenic mechanism of ischemic stroke. However, even a high-grade ICA stenosis carries a greatly variable annual risk of stroke, as high as 13% following a recent occurrence of transient or minor cerebral ischemia or as low as 1-2% in clinically asymptomatic patients. There is increasing evidence that inflammatory processes play a central role in atherosclerosis and particularly in plaque destabilization converting chronic atherosclerosis into an acute neurological disorder. In thromboendarterectomy specimens from patients with high-grade ICA stenoses, the extent of inflammatory infiltration and the expression of matrixmetalloproteinase-9 correlated to clinical and ultrasonic features of plaque destabilization such as cerebral microembolism. Inflammation might become a new therapeutic target in symptomatic carotid artery disease.     

脑梗死血浆正五聚蛋白3的动态改变及与颈动脉不稳定斑块的关系

目的研究急性缺血性脑卒中与血浆正五聚蛋白3(pentraxin 3,PTX3)水平的关系,并探索血浆PTX3水平与颈动脉粥样硬化的关系。方法纳入急性缺血性脑卒中患者共103例,对照组患者83例。应用酶联免疫吸附法(ELISA)检测所有患者入院时的血浆PTX3水平,以及急性缺血性脑卒中患者规律治疗第7天的血浆PTX3水平。对急性缺血性脑卒中患者进行颈部多普勒血管超声检查,根据颈动脉斑块稳定性将患者分为两组。研究血浆PTX3水平与急性缺血性脑卒中及颈部斑块稳定性之间的关系。结果 (1)急性缺血性脑卒中组的血浆PTX3水平明显高于对照组(P0.05),经规律治疗7 d后,恢复期的血浆PTX3水平明显低于急性期(P0.05),但仍高于对照组(P0.05)。经多因素Logistic回归后提示血浆PTX3水平与急性缺血性脑卒中密切相关(OR=15.043,95%CI:3.46~65.45,P0.001)。(2)急性缺血性脑卒中组中,不稳定斑块组急性期和恢复期的血浆PTX3水平均高于无斑块与稳定斑块组(P0.05)。结论急性缺血性脑卒中患者具有较高的血浆PTX3水平,伴有颈动脉不稳定斑块的急性缺血性脑卒中患者血浆PTX3水平更高。血浆PTX3水平与急性缺血性脑卒中密切相关。     

Study on the Prevalence and Corelation of Carotid Atherosclerosis in Stroke Patients

Objective To assess the prevalence and severity of carotid atherosclerosis in stroke patients and the risk factors of carotid atherosclerosis. Methods Two hundred fifty-one ischemic stroke patients,46 ccrcbral hemorrhagc patients and 96 control subjects were entercd into this study. Sonographic assessment of the extracranial carotid arteries was performed in all patients. Diametcr. IMT, plaques and percentage ratio of lumen stenosis were observcd. Results (1)The prevalence of carotid plaqucs was prominent in stroke patients than the control subjects(63.0%vs 36.5%). (2)The prevalencc of lumen stenosis＞50% in ischemic stroke patients was higher than the cerebral hemorrhage patients and control subjects (15.6% vs 4.3%. 2.1%).(3) The prevalence of severe carotid artery stcnosis(＞75%) was promincnt in aged 61～70 years old patients.(4)Our data revealed 30% of the cortical infarction subgroup, 17.5%of the subcortical infarction subgroup, 17% of the lacunar infarction subgroup,8% of the vcrtibral-basilar artery infarction subgroup.2.8% of thc CT normal subgroup possessed carotid stcnosis ＞50%. (5)Age, diabetes mellitus and ApoAl(inversely) were independent predictors of the extracranial carotid atherosclcrosis. Discusssion (Ⅰ)There is close relation between extracraniai carotid atherosclerosis and ischemic cerebrovascular disease.(2)The extent of serious carotid artery stcnosis in aged patients was lower.(3)Thc severity of extracranial carotid artery atherosclerosis was prominent in patients with conical infarction. Conclusion There is a high prevalence of extracranial carotid atherosclerosis in Chinese stroke patients.     

High-risk carotid plaques and incident ischemic stroke in patients with atrial fibrillation in the Cardiovascular Health Study

Background and purpose

Whether carotid artery disease could improve stroke risk stratification tools in patients with atrial fibrillation (AF) remains uncertain. This study was undertaken to investigate the risk of ischemic stroke associated with occlusive and nonocclusive carotid atherosclerotic disease in patients with AF in the prospective population-based Cardiovascular Health Study.

Methods

We included participants aged ≥65 years with AF. We used multivariable Cox regression analysis to explore the risk of ischemic stroke associated with the percentage of carotid stenosis, plaque irregularity, echogenicity, and vulnerability (markedly irregular, ulcerated, or hypoechoic plaques).

Results

A total of 1398 participants were included (55.2% female, 61.7% aged 65–74 years). The maximum carotid stenosis was <50%, 50%–99%, and 100% in 94.5%, 5%, and 0.5% of participants, respectively. High-risk plaques based on echogenicity and plaque irregularity were found in 25.6% and 8.9% of participants, respectively. After a median follow-up of 10.9 years (interquartile range = 7.5–15.6), 298 ischemic strokes were recorded. There was no difference in the incidence of ischemic stroke according to the degree of carotid artery stenosis (p = 0.44), plaque echogenicity (low vs. high risk, p = 0.68), plaque irregularity (low vs. high risk, p = 0.55), and plaque vulnerability (p = 0.86). The CHA₂DS₂-VASc score was associated with an increased risk of ischemic stroke (adjusted hazard ratio = 1.28, 95% confidence interval = 1.18–1.40, p < 0.001). Both maximum grade of stenosis and plaque vulnerability were not associated with incident ischemic stroke (all p > 0.05).

Conclusions

Neither the degree of carotid stenosis nor the presence of vulnerable plaques was associated with incident ischemic stroke in this cohort of individuals with AF. This suggests that carotid disease was probably not a significant contributor to ischemic stroke in this population.