缺血性脑血管病患者颅外动脉狭窄与肾动脉狭窄的关系

目的 探讨缺血性脑血管病(ICVD)患者颅外动脉狭窄与肾动脉狭窄(RAS)的关系.方法 对310例ICVD患者行全脑数字减影血管造影(DSA)及肾动脉造影检查,分析颅外动脉狭窄程度及数量与RAS率的关系.结果 颅外动脉重度狭窄及闭塞组的RAS率显著高于轻、中度狭窄组及无狭窄组(均P＜0.01);2支及≥3支颅外动脉狭窄患者的RAS率显著高于无狭窄及1支血管狭窄的患者(P ＜0.05 ～0.01).重度颅外动脉狭窄及闭塞、2支、≥3支颅外动脉狭窄是RAS的危险因素(OR=3.025,OR=3.343,OR=5.733;均P＜0.01).结论 重度颅外动脉狭窄及闭塞、≥2支颅外动脉狭窄是ICVD患者RAS的危险因素.     

缺血性脑卒中患者血清尿酸水平与颅内动脉狭窄的关系

目的 研究缺血性脑卒中患者血清尿酸水平与颅内动脉狭窄的关系.方法 对60例缺血性脑卒中患者进行数字减影血管造影检查,根据其颅内动脉狭窄程度分为狭窄组与无狭窄组.检测其血清尿酸、血脂及同型半胱氨酸(Hcy)水平,并进行比较.结果 根据DSA检查结果,将患者分为狭窄组(45例)和无狭窄组(15例).狭窄组男性、高血压、糖尿病、吸烟史、饮酒史、高血脂的比率及血尿酸水平显著高于无狭窄组(P ＜0.05～0.01).Logistic回归分析显示,高血压是颅内动脉狭窄的独立危险因素(OR=55.730,95％CI:1.100 ～2823.152;P ＜0.05).结论 高尿酸与颅内动脉狭窄有关,但不是其独立危险因素.     

老年脑梗死患者血同型半胱氨酸水平与颈动脉狭窄的相关性研究

目的研究65岁以上老年脑梗死患者血同型半胱氨酸(homocysteine,Hey)水平与颈动脉狭窄之间的关系。方法从本院2007年1月~2009年12月在本医院神经内科收治的脑梗死患者中选择动脉粥样硬化性脑梗死198例,均行颈部血管双源CT(dualsource CT,DSCT)扫描,并比较不同组别颈动脉狭窄程度与血同型半胱氨酸水平的关系。结果发现无狭窄61例;有狭窄137例,其中轻度狭窄55例、中度狭窄48例,重度狭窄34例。无狭窄患者血Hcy水平(12.88±3.59)μmol/L明显低于有狭窄患者(23.22±4.68)μmol/L(P0.001)。轻度狭窄组血Hcy水平(18.44±6.35)μmol/L明显低于中度狭窄组(22.52±5.58)μmol/L,中度狭窄组明显低于重度狭窄组(27.33±5.36)μmol/L,各组间Hcy水平比较有显著差异(P0.05)。Pearson等级相关分析显示,血Hcy水平与颈动脉狭窄呈正相关(r=0.411,P0.001)。颈动脉粥样硬化危险因素Logistic回归分析显示高半胱氨酸血症(HHcy)不构成颈动脉狭窄独立危险因素(P=0.238)。结论血Hcy水平与颈动脉狭窄之间无明显关系,且不是颈动脉狭窄的独立危险因子。     

踝臂指数对颅内动脉狭窄严重程度的预测价值

目的观察缺血性脑血管病患者踝臂指数(ABI)与颅内动脉狭窄程度的相关性,评价ABI对颅内动脉狭窄程度的预测价值。方法对100例行选择性全脑血管造影(DSA)的缺血性脑血管病患者进行研究,所有患者在造影前均进行ABI测量和常规生化检查。结果根据DSA结果分为正常组(21例)、轻度颅内动脉狭窄组(25例)、中度颅内动脉狭窄组(21例)、重度颅内动脉狭窄组(33例),各组ABI结果分别为:1.04±0.13、1.05±0.09、0.94±0.15、0.91±0.17,中、重度狭窄组患者ABI明显降低(P<0.01),而正常、轻度狭窄组患者的ABI无统计学差异。评价ABI对重度颅内动脉狭窄ROC曲线下面积为0.754±0.073(95%可信区间为:0.610～0.898,P=0.002),中度颅内动脉狭窄ROC曲线下面积为0.727±0.082(95%可信区间为:0.566～0.887,P=0.012)。ABI≤0.9作为截断值预测中、重度颅内动脉狭窄的特异度为81.0%,灵敏度分别为47.6%、66.7%,阳性似然比分别为2.51、3.51。Logisticd回归分析显示,在调整了收缩压、舒张压的影响后,ABI≤0...     

颈动脉内-中膜厚度和斑块对颅内动脉狭窄严重程度的预测价值

目的观察缺血性脑血管病(ischemic cerebrovascular disease,ICVD)患者颈动脉内-中膜厚度(com-mon carotid intima media thickness,CCA-IMT)和斑块与颅内动脉狭窄程度的相关性,评价其对颅内动脉狭窄严重程度的预测价值。方法对151例ICVD患者行数字减影全脑血管造影(digital subtraction angiography,DSA),根据DSA结果将患者分为颅内动脉正常、轻、中、重度狭窄组,所有患者在造影前均进行CCA-IMT、斑块检测和常规生化检测。结果中度、重度狭窄组CCA-IMT、斑块分级(carotid plaques score,CPS)较正常组及轻度狭窄组显著增高(P0.05),正常组、轻度狭窄组间及中、重度狭窄组间CCA-IMT、CPS差异无统计学意义(P0.05),CCA-IMT、CPS与颅内动脉狭窄程度呈正相关(P0.01)。CCA-IMT、CPS对中度以上颅内动脉狭窄预测价值的ROC曲线下面积分别为0.755、0.742,CCA-IMT≥1.2mm、CPS=3作为截断值预测中度以上颅内动脉狭窄的阳性似然比最高(分别为6·35、2·74)、有相对高的特异度(分别为93.5%、77.4%)和敏感度(分别为41.3%、62%)。Logistic回归分析显示,在调整了糖尿病、收缩压、舒张压的影响后,CCA-IMT≥1.2mm、CPS=3预测中度以上颅内动脉狭窄的比值比分别为5.603、3.427。结论CCA-IMT、CPS与颅内动脉狭窄程度呈正相关,CCA-IMT≥1.2mm、CPS=3对中度以上颅内动脉狭窄有一定的预测价值。     

维、汉族缺血性脑血管病患者颅内外动脉狭窄的发生率、分布及危险因素

目的 探讨维、汉族缺血性脑血管病(ICVD)患者颅内外动脉狭窄的发生率、分布及危险因素.方法 对165例汉族、108例维族ICVD患者行DSA检查,以及血糖、血脂水平检查.对两组患者的颅内外动脉狭窄发生率、分布特点和脑卒中危险因素进行统计分析.结果 汉族组有颅内外动脉狭窄103例(62.4%),维族组为70例(64.8%),两组差异无统计学意义.汉族组与维族组颅内动脉、颅外动脉及颅内外动脉狭窄的比率差异无统计学意义.汉族组患者颅内外动脉狭窄与年龄、高血压、吸烟、低高密度脂蛋白(HDL)血症有关(P<0.05～0.01);维族组患者动脉狭窄与年龄、高血压、糖尿病、高三酰甘油(TG)血症有关 (均P<0.05).Logistic多因素回归分析显示,年龄、高血压、低HDL血症是汉族组颅内外动脉狭窄的独立危险因素 (P<0.05～0.01);而维族组的则为高血压、糖尿病、高TG血症(均P<0.05).结论 维、汉族ICVD患者颅内外动脉狭窄的发生率及分布差异无统计学意义;高血压是维、汉族ICVD患者颅内外动脉狭窄的共同的独立危险因素,而年龄、低HDL血症和糖尿病、高TG血症则分别是汉族和维族的独立危险因素.     

血同型半胱氨酸与伴重度颅内动脉狭窄或闭塞的脑卒中患者侧支循环建立的关系

目的探讨伴颅内动脉重度狭窄或闭塞的急性缺血性脑卒中(CIS)患者血同型半胱氨酸(Hcy与侧支循环代偿以及患者恢复情况的的关系。方法检测116例伴颅内动脉重度狭窄或闭塞的急性患者血Hcy,根据表达水平分为高同型半胱氨酸血症(Hhcy)组和正Hcy组;采用DSA评估患者颅内侧支循环代偿情况,根据侧支循环代偿程度分成代偿差组,代偿中等组和代偿好组;根据入院及出院时进行NIHSS评分,分为恢复良好组(分值减少≥4)和恢复不良组(分值减少<4)。结果 Willis动脉环开放组Hcy水平低于未开放组;侧支循环代偿好组Hcy水平低于代偿差组;恢复良好组Hcy水平低于恢复不良组。结论 Hhcy水平不利于侧支循环的代偿,Hhcy是伴颅内动脉重度狭窄或者闭塞患者卒中恢复的影响因素。     

脑梗死患者血清同型半胱氨酸与颅内外血管狭窄的相关性

目的探讨脑梗死患者血清同型半胱氨酸(Hcy)与颅内外血管狭窄的相关性。方法对行DSA检查的116例脑梗死患者进行分组,根据DSA所提示的颅内外血管狭窄的检查结果分为颅内外血管狭窄组(91例)、颅内外血管无狭窄组(25例);按狭窄部位又将狭窄组分为单纯颅内血管狭窄组(28例)、单纯颅外血管狭窄组(34例)及颅内外血管均有狭窄组(29例)。记录所有患者的常规危险因素,如年龄、性别、高血压、糖尿病、吸烟、饮酒及血生化指标如血清同型半胱氨酸(Hcy)、甘油三脂(TG)、胆固醇(CHO)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)等。结果(1)颅内外血管狭窄组血清Hcy升高的水平及比例明显大于对照组,分别为(17.6±10.1)mmol/L和(12.6±2.6)mmol/L,P=0.002;39.6%和16.0%,P=0.002。多元逐步Logistic回归分析发现,血清Hcy水平升高(OR=1.243,95%CI:1.047～1.476,P=0.013)、HDL降低(OR=0.089,95%CI:0.014～0.551,P=0.009)是颅内外血管狭窄的危险因素。(2)对于不同的狭窄亚组,血清Hcy升高的水平及比例在各组间无差异,分别为(18.1±10.9)mmol/L、(17.0±8.9)mmol/L、(17.7±10.7)mmol/L;比例分别为42.9%、38.2%、37.9%,P=0.11;多元逐步Logistic回归分析发现,血清Hcy升高是所有狭窄亚组的重要的危险因素(OR分别为1.367、1.232、3.846)。结论血清同型半胱氨酸水平升高是颅内外血管狭窄的危险因素。     

缺血性脑卒中患者踝臂指数与颅内动脉狭窄的相关性研究

目的研究缺血性脑卒中患者踝臂指数(ABI)与颅内动脉狭窄程度的相关性,评价ABI对颅内动脉狭窄的预测价值。方法 91例缺血性脑卒中患者按照北美症状性颈动脉狭窄试验法(NASCET)分成轻度狭窄组(33例)、中度狭窄组(30例)、重度狭窄组(28例),设正常对照组(30例)。计算ABI。结果轻度狭窄组、中度狭窄组与重度狭窄组的ABI异常率分别为42.42%、56.67%、85.71%,显著高于正常对照组(P<0.05),重度狭窄组ABI异常率显著高于其他狭窄组(P<0.05)。轻度狭窄组、中度狭窄组与重度狭窄组的ABI分别为0.94±0.08、0.92±0.10与0.80±0.11,显著低于正常对照组(P<0.05),重度狭窄组ABI显著高于其他狭窄组(P<0.05)。颅内动脉狭窄程度与ABI呈负相关(r=-0.630,P<0.05)。结论ABI与颅内动脉狭窄存在明显相关性,对预测颅内动脉狭窄具有重要的临床价值。     

高同型半胱氨酸血症与颅内外血管狭窄的相关性研究

目的 探讨缺血性脑血管病患者高同型半胱氨酸(Hcy)血症与颅内外血管狭窄的关系.方法 应用全自动生化分析仪,用循环酶法检测405例缺血性脑血管病患者血清Hcy水平,同时检测血清叶酸、维生素B12水平,应用经颅多普勒(TCD)检测所有患者的颅内血管,应用双功能彩色多普勒检测颅外血管.根据检测结果将颈内动脉(ICA)分为:正常、轻度狭窄(＜50%)、中度狭窄(50%～69%)、重度狭窄(70%～99%)、闭塞;大脑中动脉(MCA)分为:正常、中度狭窄(50%～69%)、重度狭窄(70%～95%)、极度狭窄(＞95%).结果 有颅内外血管狭窄组血清Hcy水平显著高于无颅内外血管狭窄组(P<0.01),血清叶酸水平显著低于无颅内外血管狭窄组(P<0.05),血清维生素B12水平两组间差异无统计学意义(P>0.05);ICA、MCA不同程度狭窄患者间血清Hcy水平差异有统计学意义(均P<0.01),血清叶酸水平差异有统计学意义(均P<0.05),维生素B12水平差异无统计学意义(均P>0.05);Hcy水平与ICA、MCA狭窄程度呈正相关(r=0.356 ,P<0.01;r=0.345 ,P<0.01);血清叶酸水平与ICA、MCA狭窄程度呈负相关(r=-0.272 ,P<0.05;r=-0.265,P<0.05).结论 高Hcy血症与颅内外血管狭窄程度密切相关,高Hcy血症可能是缺血性脑血管病新的危险因素.     

Ophthalmic artery fed by posterior communicating artery after trapping of the internal carotid artery

The authors report a 50-year-old man with a ruptured large carotid-ophthalmic aneurysm on the right side and an unruptured anterior communicating artery (A Com) aneurysm. The A Comm aneurysm was clipped and the carotid-ophthalmic aneurysm was managed by combining internal carotid artery (ICA) trapping with an interposed radial artery graft from the external carotid artery (ECA) to the middle cerebral artery (MCA). The patient had an uncomplicated postoperative recovery. Postoperative carotid angiography demonstrated no aneurysms and excellent flow through the bypass graft. Postoperative vertebral angiography showed the right ophthalmic artery to be fed by the posterior communicating artery. It is speculated that collateral circulation from the angular artery of the ECA to the ophthalmic artery did not develop because of high flow graft from the ECA to MCA and ICA trapping.     

Superior cerebellar artery infarction and vertebral artery dissection

Isolated superior cerebellar artery infarction is rare, and the mechanism is often not readily apparent. We describe a patient with an isolated superior cerebellar artery infarction resulting from an ipsilateral vertebral artery dissection. Angiography demonstrated intraluminal clot in the superior cerebellar artery, suggesting artery-to-artery embolus as a mechanism of this uncommon stroke syndrome.     

支架成形术治疗椎动脉颅内段和基底动脉狭窄17例临床观察

目的评估症状性椎动脉颅内段、基底动脉狭窄患者经皮血管内支架成形术(PTAS)治疗的安全性和有效性。方法17例症状性椎动脉颅内段及基底动脉狭窄患者,狭窄程度在50%以上且规范的内科药物治疗无效,给予PTAS治疗,术后常规给予抗凝、抗血小板聚集、降脂药物。结果17例患者20处狭窄行PTAS,所有的病例手术均取得成功,没有严重并发症,术后即刻造影残存狭窄平均在10%以下,病人平均随访6.8个月(3～10个月),有1例患者出现再狭窄(狭窄程度>50%),所有患者均无缺血症状发作。结论PTAS治疗椎动脉颅内段及基底动脉狭窄是安全和有效的。     

Posterior cerebral artery infarction from middle cerebral artery infarction

BACKGROUND: While it is known that posterior cerebral artery (PCA) infarction may simulate middle cerebral artery (MCA) infarction, the frequency and localization of this occurrence are unknown. OBJECTIVE: To determine the frequency of PCA infarction mimicking MCA infarction and the territory of the PCA most commonly involved in this simulation. DESIGN: We studied 202 patients with isolated infarction in the PCA admitted to our stroke center to determine the frequency of PCA infarction simulating MCA infarction, the involved PCA territory, and the patterns of clinical presentation. RESULTS: We found 36 patients (17.8%) with PCA ischemic stroke who had clinical features suggesting MCA stroke. The PCA territory most commonly involved was the superficial PCA territory (66.7%), followed by the proximal PCA territory (16.7%) and both the proximal and the superficial PCA territories (16.7%). The principal stroke mechanism was cardioembolic (54.1%) in the superficial PCA territory, lacunar (46.2%) in the proximal PCA territory, and undetermined (40.2%) in both the proximal and the superficial territories. Among the 36 patients, the most common clinical associations were aphasia (13 patients), visuospatial neglect (13 patients), and severe hemiparesis (7 patients). CONCLUSIONS: Posterior cerebral artery infarction simulating MCA infarction is more common than previously thought. Early recognition of the different stroke subtypes in these 2 arteries may allow specific management.     

Embolic internal auditory artery infarction from vertebral artery dissection

A 51-year-old man developed sudden vertigo, right hearing loss and dysphagia. Examination revealed right Horner syndrome, spontaneous torsional-horizontal nystagmus, right central type facial palsy, dysarthria, reduced soft palate elevation without gag reflex, left hypesthesia, right dysmetria and imbalance. Audiometry and bithermal caloric tests documented right sensorineural hearing loss and canal paresis. Brain MRI and cerebral angiography documented right lateral medullary infarction from vertebral artery dissection, without involvement of other parts of the brainstem supplied by the anterior inferior cerebellar artery (AICA). This case suggests artery-to-artery embolism as a possible mechanism of isolated vertigo or hearing loss from labyrinthine infarction.     

Management of coexistent carotid artery and coronary artery disease

At the present time staged carotid reconstruction several days before elective coronary artery bypass surgery seems to be the safest and most logical approach for patients with neurological symptoms, stable cardiac symptoms, and acceptable coronary anatomy. Combined procedures may well be necessary for those who have active neurological symptoms or bilateral carotid lesions in conjunction with diffuse or unstable coronary artery disease, but the incidence of neurological complications at the time of simultaneous operations could exceed the stroke risk for either carotid endarterectomy or coronary bypass alone. The asymptomatic patient with unilateral carotid stenosis who presents for coronary artery bypass might be best managed by myocardial revascularization followed by medical or surgical management of the carotid disease. In order to obtain optimal long-term results, both coronary disease and associated carotid disease require appropriate evaluation and medical and surgical management.     

The relation of retinal artery occlusion and carotid artery stenosis

We retrospectively studied 46 patients with symptomatic retinal artery occlusion and assessed the pattern and extent of carotid artery disease ipsilateral to the retinal artery occlusion. Ipsilateral internal carotid artery atherosclerotic lesions were virtually limited to the cervical arterial segment; 50% of such lesions were plaques or stenoses of less than or equal to 60%, whereas 15% of the angiograms were normal. No clinical features were significantly associated with a flow-limiting carotid stenosis of greater than 60%. Contrary to previous reports, the type of retinal artery occlusion, whether branch or central artery occlusion, was not predictive of severe underlying carotid stenosis or occlusion. Likely mechanisms of retinal artery occlusion include in situ thrombosis and emboli from carotid, and possibly cardiac, sources. Extension of thrombus from an occluded carotid artery into the ophthalmic artery did not appear to be a mechanism of retinal artery occlusion.