颅内大动脉狭窄的检查方法和流行病学调查

近几十年来人们已经知道颅外颈动脉狭窄是获美卒中患者发病的主要原因，而颅内动脉粥样硬化性狭窄则是亚洲患者卒中的重要原因。由于不同病变部位导致缺血性卒中的病理生理机制不完全相同，使不同病因引起的卒中往往需要不同的个体化治疗和预防，因此了解亚洲患者颅内脑动脉硬化性狭窄的发病情况对中国卒中患者非常重要。数字减影血管造影（digital subtract angiography，DSA）是判断脑血管狭窄的金指标，但也是一项创伤性检查，因此无法用其进行颅内脑血管狭窄的筛查及流行病学调查。而近20年中蓬勃发展起来的无创性经颅多普勒超声（transcranial doppler，TCD）和磁共振血管成像（digital magnetic resonance angiography，MRA），为调查和研究颅内血管狭窄提供了可能，并已逐渐取代创伤性DSA检查。本文总结了香港中文大学威尔斯亲五医院和中国医学科学院北京协和医院在近10年中应用上述现代影像学技术进行的一系列研究，并回顾了国内外文献，现就以下两方面进行探讨：（1）颅内血管狭窄的检查方法；（2）颅内血管狭窄的流行病学调查。

Diagnosis and epidemiology of large intracranial artery stenosis

Extracranial carotid artery occlusive disease is a major cause of ischemic stroke in Caucasians.However,intracranial artery occlusive disease,especially middle cerebral artery(MCA)stenosis is more significant in Asians.The underlying mechanisms of ischemic stroke with intracranial artery occlusive lesions is different from that of extracranial artery it is expected to recognize the pathogenesis and epidemiology of intracranial artery occlusive disease.By digital magnetic resonance angiography(MRA)and transcranial doppler(TCD)instead of traumatc subtract angiography methods for screening diagnosis of intracranial artery stenosis that were developed in recent two decades.In current paper,we summarized the results studied with MRA and TCD in Peking Union Medical College Hospital and Chinese University of Hong Kong with literatures reviews in this field.Two aspects are discussed(1)Methods for diagnosis of intracranial artery stenosis;(2)Epidemiology of intracranial artery stenosis.