经颅多普勒超声诊断颅内段后循环动脉狭窄或闭塞的应用价值

目的 探讨经颅多普勒超声（TCD）诊断颅内段后循环动脉狭窄或闭塞的敏感性和特异性.方法 选取颅内段后循环动脉狭窄或闭塞的患者72例,进行TCD和CT血管造影术（CTA）检查,并进行对比分析.结果 与CTA相比,TCD对颅内段后循环动脉检查的敏感性为82.50％,特异性为94.64％,阳性预测值为91.67％,阴性预测值为88.33％,准确性为89.58％.结论 TCD对颅内段后循环动脉病变的诊断特异性高,敏感性一般,其中对颅内段椎动脉的诊断准确性最高.TCD可作为颅内动脉病变的早期筛查手段.     

肝素与冠心病血管生成治疗认识进展

冠 心病心肌缺血或坏死的发生 ,与病变血管的闭塞直接相关。随着介入治疗和“搭桥”手术的不断开展和技术日趋完善 ,挽救存活心肌成为临床治疗冠心病的焦点。血管生成治疗促进侧枝循环的建立是改善心肌缺血的另一重要途径。本文旨在介绍肝素临床应用在血管生成治疗、促进侧枝循环建立的认识进展。1　侧枝循环与血管生成治疗冠心病患者冠状动脉逐渐狭窄至闭塞常常与侧枝循环的发生有关。尽管这类患者侧枝循环的存在与临床症状改善有关 ,但并不能完全代偿病变血管的血流下降。虽然在此情况下 ,侧枝循环血流储备受到限制的原因尚不清楚[1] 。然…     

TCD、MRA对儿童脑血管烟雾病诊断的对比研究

目的 探讨经颅多普勒超声（TCD）在儿童烟雾病的特征表现并与核磁共振（MRA）对照比较其诊断价值。方法 对6例由MRA确诊为烟雾病患儿的TCD检查资料比较分析。结果 6例患者TCD获得的检测结果具有一定的特征性，TCD所测出的病变血管与MRA证实的病变部位基本符合，TCD与MRA对照分析结果：①MRA显示血管狭窄，TCD均见相应动脉血流速度增快；②MRA显示血管严重狭窄，TCD显示该血管血流速度减慢、血流频谱降低或无血流信号；③椎动脉系统因其与颈内动脉系统由后交通动脉相连，当颈内动脉系统出现狭窄闭塞，椎动脉系统血流代偿性增快，也为TCD所证实。结论 TCD作为一种无创的检查手段，可以对烟雾病患者的脑血流进行追踪观察，对于烟雾病的早期诊断，具有重要的临床意义，并且具有明显优势。     

脑电图空间对称指数与单侧大脑中动脉狭窄后侧支循环状态的相关性

目的：探讨脑电图空间对称指数（spatial hemispheric brain symmetry index, sBSI）与大脑中动脉（McA）狭窄后患者侧支循环代偿之间的关系。方法：对25例单侧MCA重度狭窄或闭塞的患者（病例组）和15例健康者（对照组）进行16导联脑电图常规检查,计算出脑电图sBSI。病例均为经脑血管造影术（DsA）证实为MCA狭窄或闭塞。再将病例组分为有明显侧支循环代偿组和无明显代偿组两组,观察脑电图sBSI与MCA狭窄或闭塞后有无侧支代偿的关系。结果：lO例MCA闭塞病变患者中8例有明显侧支代偿。15例MCA重度狭窄患者中5例具有明显侧支代偿。病例组sBSI（0．078±0．025）明显大于正常对照组sBSI（0．058±0．010）,P=0．004;有侧支代偿病例组的脑电图sBSI（0．068±0．009）明显小于无侧支的病例组sBSI（0．092±0．032）,P=0．011。结论：脑电图检查作为一项无创的检查方法,其sBSI在评估MCA狭窄或闭塞后侧支代偿状态有一定的可行性。     

颈动脉流场改变对斑块稳定性影响及脑梗死分型特点分析

目的探讨颅外段颈动脉狭窄所致血流动力学变化对斑块稳定性影响;分析脑梗死分型与责任血管狭窄程度、斑块稳定性关系,为脑梗死发病机制、临床诊断、治疗和预防提供重要依据。方法对168例急性脑梗死患者分别行64排CT头颈部血管成像(CTA)及彩色多普勒血流显像仪(CDFI)检查,部分经CTA证实为中、重度狭窄及闭塞者于脑梗死恢复期行DSA检查,根据其责任血管狭窄程度,将168例患者分成颈动脉正常组、轻度狭窄组、中度狭窄组,重度狭窄组及闭塞组,结合CDFI及CTA评价斑块性质及流场改变,对梗死灶进行急性脑梗塞的牛津郡社区卒中计划(OCSP)分型,再根据CTA所示脑梗死部位,将患者分为皮质、基底节区、放射冠和后循环梗死4种亚型。观察流场改变对斑块稳定性影响并对比不同程度颈动脉狭窄后脑梗死临床分型特点。结果 168条责任血管,正常17.9%,轻度狭窄22.6%,中度狭窄30.9%,重度狭窄14.8%,闭塞14.3%,中度狭窄比例最高。狭窄程度大于50%即可导致流场改变,血流速度增快,湍流形成,斑块不稳定性增加,以脂质斑及混合斑比例最高。临床部分前循环梗死(PACI)多见,重度狭窄及闭塞组颈动脉斑块以混合斑多见,临床以分水岭梗死多见。轻度狭窄组,多为纤维斑块,临床以腔隙性梗死(LI)多见。结论颈动脉中度狭窄因特殊的血流流场变化导致斑块不稳定性增高,易发生动脉-动脉栓塞。     

TCD、MRA对儿童脑血管烟雾病诊断的对比研究

目的探讨经颅多普勒超声(TCD)在儿童烟雾病的特征表现并与核磁共振(MRA)对照比较其诊断价值.方法对6例由MRA确诊为烟雾病患儿的TCD检查资料比较分析.结果 6例患者TCD获得的检测结果具有一定的特征性,TCD所测出的病变血管与MRA证实的病变部位基本符合. TCD与MRA对照分析结果:①MRA显示血管狭窄,TCD均见相应动脉血流速度增快;②MRA显示血管严重狭窄,TCD显示该血管血流速度减慢、血流频谱降低或无血流信号;③椎动脉系统因其与颈内动脉系统由后交通动脉相连,当颈内动脉系统出现狭窄闭塞,椎动脉系统血流代偿性增快,也为TCD所证实.结论 TCD作为一种无创的检查手段,可以对烟雾病患者的脑血流进行追踪观察.对于烟雾病的早期诊断,具有重要的临床意义,并且具有明显优势.     

Onyx胶栓塞在颅内动静脉畸形治疗中的应用

目的：探讨颈动脉硬化基础上单侧颈内动脉（ICA）闭塞后侧支循环开放与临床表现之间的关系.方法：根据临床表现,将54例经数字减影血管造影（DSA）检查确诊的单侧ICA闭塞患者分为脑梗死组（A组）、短暂性脑缺血发作（TIA）组（B组）和无症状组（C组）共3组,并对3组侧枝循环开放情况进行对比分析.结果：本组54例中,44例形成侧支循环,其中前交通动脉（ACOA）开放占38.9%,后交通动脉（PCOA）开放占33.3%,眼动脉（OA）开放占31.5%;ACOA、PCOA、OA的开放例数,A组和B组明显少于C组（P＜0.05）,而A组又明显少于B组（P＜0.05）;C组侧支循环开放例数明显多于A组和B组（P＜0.05）.结论：单侧ICA闭塞后,侧支循环开放与否与临床症状的严重程度密切相关.ACOA开放对改善临床症状较PCOA和OA开放者明显.     

短暂性脑缺血发作患者脑血流动力学研究

目的探讨短暂性脑缺血发作(TIA)的发病机制及血流动力学变化。方法52例符合TIA诊断标准的患者入选试验组,40例健康人作对照组。对上述受检者依次进行(1)经颅多普勒超声(TCD)检查:观察颅内血管有无狭窄、闭塞、侧支循环代偿状况;(2)彩色多普勒血流显像(CDFI)检查:了解颈动脉血管有无狭窄及斑块形态改变;(3)随访1年。结果52例TIA患者中,TCD检查发现40例(76.92%,40/52)有颅内动脉狭窄,其中多发动脉狭窄(两条或两条以上血管狭窄)26例(50%,26/52),单发动脉狭窄14例(26.92%,14/52),无狭窄10例(19.23%,10/52)。CDFI检查发现35例(67.31%,35/52)有1侧或双侧颈动脉狭窄。随访1年,48例完成随访的TIA患者中,13例有脑血管事件再发(27.08%,13/48),其中颅内外血管高度狭窄者脑血管事件再发率高于中度狭窄者(P<0.05);颈动脉软斑型粥样硬化狭窄患者脑血管事件再发率高于硬斑型粥样硬化患者(P<0.05)。结论TIA的发生与颅内外动脉狭窄有关,颅内外血管狭窄程度越高,脑血管事件再发的危险性也越大。颈动脉软斑型粥样硬化斑块比硬斑型斑块更不稳定,易引起脑缺血事件。     

短暂性脑缺血发作患者脑血流动力学研究

目的 探讨短暂性脑缺血发作(TIA)的发病机制及血流动力学变化.方法 52例符合TIA诊断标准的患者入选试验组,40例健康人作对照组.对上述受检者依次进行(1)经颅多普勒超声(TCD)检查:观察颅内血管有无狭窄、闭塞、侧支循环代偿状况;(2)彩色多普勒血流显像(CDFI)检查:了解颈动脉血管有无狭窄及斑块形态改变;(3)随访1年.结果 52例TIA患者中,TCD检查发现40例(76.92%,40/52)有颅内动脉狭窄,其中多发动脉狭窄(两条或两条以上血管狭窄)26例(50%,26/52),单发动脉狭窄14例(26.92%,14/52),无狭窄10例(19.23%,10/52).CDFI检查发现35例(67.31%,35/52)有1侧或双侧颈动脉狭窄.随访1年,48例完成随访的TIA患者中,13例有脑血管事件再发(27.08%,13/48),其中颅内外血管高度狭窄者脑血管事件再发率高于中度狭窄者(P＜0.05);颈动脉软斑型粥样硬化狭窄患者脑血管事件再发率高于硬斑型粥样硬化患者(P＜0.05).结论 TIA的发生与颅内外动脉狭窄有关,颅内外血管狭窄程度越高,脑血管事件再发的危险性也越大.颈动脉软斑型粥样硬化斑块比硬斑型斑块更不稳定,易引起脑缺血事件.     

CT血管成像术在胭动脉陷迫综合征的应用

目的探讨CT血管成像术（CTA）在动脉陷迫综合征（PAES）诊断中的应用价值。方法回顾性分析8例经手术病理证实的PAES患者的CTA资料，其中4例行数字减影血管造影（DSA）检查。结果CTA图像可清晰显示8例患者动脉与周围组织之间的关系，均可见异常走行的腓肠肌内侧头及其肌腱或纤维组织束压迫动脉。CTA能清晰显示动脉狭窄闭塞的部位、范围、程度、侧枝循环形成情况及动脉与周围组织间的关系。结论CTA诊断PAES准确率100％，明确病因诊断优于DSA。     

颈动脉切除术的体会

目的:探讨颈动脉切除术的安全检测指标,确保手术成功和患者生命安全.方法:19例行颈动脉切除的肿瘤患者采用术前体外或体内颈动脉压迫训练法,阻断颈动脉血流,通过经颅多普勒(TCD)和数字减影(DSA)检测了解脑侧支循环建立及交通动脉开放情况.术中夹闭颈总动脉,TCD检测患侧大脑前动脉(ACA)和大脑中动脉(MCA)代偿情况.结果:体外压迫训练18～45 d,体内压迫训练7～9 d达到合格标准.18例肿瘤全切,1例肿瘤包绕椎动脉入颅处行部分切除.无死亡病例和术后脑缺血及偏瘫等严重并发症.16例随访1～5 a无复发.结论:缓慢渐进的颈动脉压迫训练是促进脑侧支循环建立和患侧脑血流代偿的有效方法.TCD和DSA检测对手术成功和保障患者生命安全起决定性作用.     

MR imaging findings of moyamoya disease

The brain MR images of 23 patients with angiographically proved moyamoya disease were reviewed to evaluate the capability of MR to demonstrate vascular and parenchymal abnormalities. All the MR images were obtained on a 2.0 T superconducting system and included T1-weighted sagittal and T2-weighted axial images without implementation of flow compensation (FC). The vascular abnormalities demonstrated on MR images were narrowing of the cavernous internal carotid artery (ICA) (73%), narrowing or occlusion of the supraclinoid ICA (87%) and proximal middle cerebral artery (MCA) (91%), and multiple collateral vessels in the basal ganglia and/or thalamus (96%). The parenchymal abnormalities included ischemic infarctions (74%), predominantly located in watershed areas, hemorrhagic infarctions (26%), intracerebral hematomas (13%), and intraventricular hemorrhage (13%). In conclusion, MR imaging was a useful diagnostic modality for detecting both vascular and parenchymal abnormalities associated with moyamoya disease. This may obviate the need for invasive angiography as far as the diagnosis is wanted at the non-quantitative level.     

Imaging of cerebrovascular disease in sickle cell anemia

Cerebral vascular disease is a common and serious complication of sickle cell disease that mainly involves the large blood vessels of the skull base. Because recurrences are common and residual deficits severe, attention has turned to detection of preclinical cerebral involvement with the goal of preventing clinical damage. Magnetic resonance imaging (MRI), an extremely sensitive tool for detecting cerebral infarction/ischemia, has shown that 10% of asymptomatic patients exhibit white matter lesions that seem to be associated with impaired cognitive function and may be predictive of stroke; magnetic resonance angiography demonstrates occlusions of skull base arteries but is not reliable for the diagnosis of stenosis because of artifacts generated by rapid turbulent flow. Transcranial Doppler is sensitive and specific for the detection of arterial stenosis and occlusion, even in asymptomatic patients. Digitized cerebral angiography remains the gold standard investigation for pretreatment confirmation of lesions detected by Doppler and/or MRI.     

单侧颈内动脉闭塞后侧支循环开放及其临床表现

目的：探讨在清醒状态下颅内动脉狭窄支架置入术的可行性及临床意义.方法：2007年2月到2008年1月,在局麻下应用血管内支架置入术治疗颅内动脉狭窄患者12例,其中颈内动脉系狭窄7例,椎-基底动脉系狭窄5例.结果：本组12例均成功接受了血管内支架置入,术中患者清醒,配合良好,无不良反应.术后6个月复查DSA提示,颅内动脉狭窄程度由原来的67.5%±9.5%下降至9.5%±2.8%（P＜0.01）.随访12～23个月,12例患者症状均改善,无卒中发生.结论：局麻下行血管内支架置入术治疗颅内动脉狭窄,可将重要并发症的危险性降到最低;颅内动脉痛觉神经并不敏感,完全可以承受介入支架置入操作.     

Application of arterial spin labeling and susceptibility weighted imaging in the diagnosis of ischemic cerebrovascular diseases

Objective: To investigate the application value of arterial spin labeling (ASL) and susceptibility weighted imaging (SWI) in the diagnosis of acute ischemic cerebrovascular disease (CVDs). Methods: A total of 124 patients who received fluid attenuated inversion recovery (FLAIR), diffusion weighted imaging (DWI), ASL, time of flight magnetic resonance angiography (TOF-MRA) and SWI scan sequentially were included in this study. The area of the abnormal perfusion region was compared with that of the restricted diffusion region. The cerebral blood flow (CBF) value and apparent diffusion coefficient (ADC) value were compared in ischemic penumbra (IP), infarct core and mirror region. The susceptibility vessel sign (SVS) detection rate was compared with the major vessel severe stenosis or occlusion rate as revealed by MRA. A receiver operating characteristic curve (ROC) was used to analyze the value of SVS as revealed by SWI. Results: In total, 124 cases were included in this study, and 77 cases showed acute cerebral infarction. Among the 77 cases, 59 cases showed an IP. There were significant differences in ADC and CBF values between the infarct core and mirror region (P < 0.01). There was no significant difference in ADC value between IP and mirror region (P = 0.176), but there was significant difference in CBF value between IP and mirror region (P < 0.01). There was no significant difference in SVS detection rate compared with the vessel severe stenosis or occlusion rate in MRA (P = 0.111). Based on the MRA standards, the area under curve (AUC) of ROC for the SVS as revealed by SWI was 0.86 (95% CI: 0.753-0.962). Conclusions: ASL combined with DWI contributed to IP evaluation of acute cerebral infarction. SWI showed higher diagnostic value for intravascular thrombus in acute cerebral infarction.     

Posterior Cerebral Artery Occlusion Without Hemianopia

A 42-year-old man had ischemic infarction from an occlusion of the left posterior cerebral artery (PCA), but had no visual field defect by examination or Goldmann perimetry. Arteriograms showed distal filling of the occluded PCA, but no collateral blood flow from the carotid circulation, suggesting collateral flow from leptomeningeal anastomoses. Visual field sparing may occur in surgical occlusion of the PCA, but rarely occurs in stroke. An infarction from PCA occlusion is not excluded by complete visual field sparing, and studies looking for other causes of the neurologic deficit may not be necessary.     

短暂性脑缺血发作病人经颅多普勒分析

目的：评价经颅多普勒超声（TCD）对短暂性脑缺血发作（TIA）的诊断价值。方法：应用经颅多谱勒超声对38例短暂性脑缺血发作病人进行检查。结果：38例TIA患者进行常规TCD检查,其中脑动脉硬化26例,占68％,其中血管狭窄14例,占37％,血流速度减慢12例,占32％,血管痉挛8例,占21％,正常4例,占11％,总异常率89％。结论：TCD检测对于诊断TIA有重要的临床意义。     

Neuro DSA CT评价中西医结合治疗分水岭脑梗死疗效

目的探讨采用Neuro DSA CT评价中西医结合治疗分水岭脑梗死的疗效。方法将46例分水岭脑梗死患者随机分为治疗组及对照组。治疗组采用常规西医治疗加中药治疗,对照组采用常规西医治疗,用Neuro DSA CT评价对比两组病人脑内分支血管改善情况。结果治疗组脑内分支血管改善与对照组比较有显著性意义(P0.05)。结论 Neuro DSA CT可以作为中西医结合治疗分水岭脑梗死疗效的一个判断指标。