脑动脉与冠状动脉粥样硬化狭窄的相关性

目的:探讨脑动脉粥样硬化狭窄与冠状动脉狭窄的相关性。方法:对66例经冠状动脉造影确诊为冠心病的患者同时行脑血管造影。据冠状动脉造影结果分2组,A组(冠状动脉狭窄1支和2支者)30例,B组(冠状动脉狭窄3支者)36例。比较2组脑动脉轻度、中重度狭窄的发生率及颈动脉系统、椎-基底动脉系统狭窄的发生率。结果:B组脑动脉中重度狭窄的发生率、颈动脉系统狭窄发生率明显高于A组,但椎-基底动脉系统狭窄性病变发生率,2组比较差异无统计学意义。结论:脑动脉粥样硬化狭窄程度及发生率与冠状动脉狭窄的程度明显相关。     

颅内外动脉粥样硬化对冠状动脉狭窄影响的交互作用

目的 基于颈动脉超声、经颅多普勒超声（TCD）分析颅内外动脉粥样硬化对冠状动脉狭窄影响的交互作用。方法选取宁波市医疗中心李惠利医院2019年1月至2021年6月收治的235例疑似冠状动脉狭窄患者为研究对象,根据入院时冠状动脉CT血管造影结果分为非狭窄组（无狭窄或轻度狭窄）161例和狭窄组（中重度狭窄）74例。比较两组患者颈动脉超声、TCD参数,分析颈动脉超声、TCD参数与冠状动脉狭窄程度的相关性,同时分析颅内外动脉粥样硬化对冠状动脉狭窄影响的交互作用。结果 狭窄组颈动脉内中膜厚度（IMT）以及大脑中动脉（MCA）、椎动脉（VA）、大脑前动脉（ACA）、大脑后动脉（PCA）、基底动脉（BA）的搏动指数（PI）和阻力指数（RI）均明显高于非狭窄组,差异均有统计学意义（均P<0.05）。IMT以及MCA、VA、ACA、PCA、BA的PI和RI与冠状动脉狭窄程度均呈正相关（rs=0.579～0.817,均P<0.05）。以无颈动脉粥样硬化、无颅内动脉粥样硬化为对照,颈动脉粥样硬化、颅内动脉粥样硬化与冠状动脉狭窄有关（OR=3.584、1.065,均P<0.05）;颈动脉粥样硬...     

颈动脉粥样斑块与冠状动脉病变的相关性研究

目的探讨颈动脉粥样硬化斑块与冠状动脉病变的临床相关性。方法选择行冠状动脉造影确诊的冠状动脉病变患者133例。根据冠状动脉造影检查结果,按照病变严重程度,分为轻度狭窄组、中度狭窄组和重度狭窄组;按照冠状动脉病变支数,分为单支病变组、双支病变组和三支病变组;按照SYNTAX积分,分为0～22分组、23～32分组和≥33分组。超声检测入选患者颈总动脉、颈内动脉、颈外动脉及其分叉处有无斑块形成并进行粥样硬化斑块积分（AS积分）,分析各组颈动脉粥样硬化斑块及积分与冠状动脉病变的相关性。结果颈动脉粥样斑块形成例数及粥样硬化斑块积分与冠状动脉病变严重程度呈正相关（r分别为0.632、0.751）;与冠状动脉病变支数呈正相关（r分别为0.597、0.655）;与SYNTAX积分呈正相关（r分别为0.643、0.597）。冠状动脉轻度狭窄组与中度及重度狭窄组比较,单支病变组与双支及三支病变组比较,冠状动脉SYNTAX积分0～22分组与23～32分组及≥33分组比较,颈动脉粥样斑块形成例数及粥样硬化斑块积分差异均具有统计学意义（P〈0.05～0.01）;冠状动脉中度与重度狭窄组比较,双支及三支病变组比较,SYNTAX积分23～32分组比较与≥33分组比较,颈动脉粥样斑块形成例数及粥样硬化斑块积分差异无统计学意义（P均〉0.05）。结论颈动脉粥样斑块检查能够反映冠状动脉病变的情况,适合临床冠心病的普查及随访。     

颈动脉斑块超声与冠状动脉狭窄关系分析

目的通过颈动脉超声及冠状动脉造影检测,探讨颈动脉斑块与冠状动脉狭窄之间的关系。方法入选105例拟诊为冠状动脉粥样硬化性心脏病(冠心病)的患者,根据患者冠状动脉造影结果将分为正常组(n=15)和病变组(n=90),病变组根据病变程度分为轻度病变组(n=18),中度病变组(n=40)及重度病变组(n=32)。颈动脉超声检查颈动脉斑块面积、数目、血管内中膜厚度(IMT)情况。结果 105例患者,经颈动脉超声检测80例有颈动脉斑块:正常组有颈动脉斑块者6例(40.0%),病变组72例(80.0%)。颈动脉狭窄者49例,其中轻度狭窄者18例,中度狭窄者22例,重度狭窄者9例。冠状动脉造影正常组与各病变组之间颈动脉斑块面积、斑块数目、IMT相比较,病变组患者颈动脉斑块面积、斑块数目、IMT均明显高于正常组,差异均有统计学意义(P0.05),且随者病变程度的增加,斑块面积、斑块数目、IMT也呈增加趋势(P均0.05)。颈动脉狭窄率随冠状动脉的狭窄程度的增加而升高,差异有统计学意义(P0.05)。结论颈动脉硬化形成斑块随冠状动脉狭窄严重程度呈增加趋势,临床中可以应用颈动脉超声检查来预测冠状动脉病变。     

颈动脉粥样硬化与冠状动脉狭窄程度的关系

探讨颈动脉粥样硬化病变的性质、程度及其与冠状动脉狭窄程度的关系。选择200例冠状动脉造影患者，并经颈动脉DSA及B超检查。根据造影结果分为冠心病组和非冠心病组(对照组)。根据冠状动脉狭窄直径，冠心病组再分成三个亚组。结果发现，颈动脉粥样硬化与冠状动脉狭窄之间呈线性正相关，颈动脉狭窄较冠状动脉狭窄发生率低，但随着冠状动脉狭窄程度加重，颈动脉粥样斑块的发生率明显增加，且颈动脉狭窄亦有加重趋势。结果提示，颈动脉粥样硬化与冠状动脉狭窄密切相关。对中年以上人群，尤其是有多种危险因素者，常规进行颈动脉超声检查，可为早期发现和筛选心脑血管疾病高危患者提供依据。     

灌注磁共振结合脑血管造影评估短暂性脑缺血发作

目的研究颈动脉系统短暂性脑缺血发作(transient ischemic attack,TIA)患者经灌注磁共振(PWI)后的改变与颈动脉狭窄的相关性。方法对49例颈内动脉系统TIA行全脑数字减影血管造影(DSA)及PWI检查,根据颈动脉狭窄程度分为轻度狭窄组(8例)、中度狭窄组(11例)、重度狭窄组(21例)、极重度狭窄组(9例)。研究颈内动脉狭窄程度、局部脑血流量(rCBF)和达峰时间(TTP)。结果4组患者间rCBF和同组患侧rCBF与对侧rCBF比较,差异均无统计学意义(P>0.05),中度狭窄组、重度狭窄组和极重度狭窄组患侧TTP与对侧TTP比较,差异有统计学意义(P<0.01),重度狭窄组和极重度狭窄组的TTP分别较轻度狭窄组和中度狭窄组明显延迟(P<0.05)。随着脑动脉狭窄程度的加重,患侧TTP呈线性增加趋势(P<0.05)。结论DSA可以对颈动脉狭窄程度做出准确评价,PWI在评价脑循环的血流动力变化方面有重要的作用,其中TTP较rCBF对颈动脉狭窄引起的缺血性改变更为敏感。     

血清胱抑素C与颈动脉狭窄程度的相关性研究

目的　探讨短暂性脑缺血发作或小卒中患者血清胱抑素C（Cys　C）与颈动脉狭窄程度的关系。方法　选择完成头颈部CT血管造影（CTA）检查的短暂性脑缺血发作或小卒中患者共计229例,分为颈动脉狭窄组127例（包括轻度狭窄组57例、中度狭窄组34例、重度狭窄组24例、闭塞组12例4个亚组）和非狭窄组102例。应用免疫比浊法测定血清Cys　C水平,分析血清Cys　C水平与颈动脉狭窄程度之间的相互关系。结果　颈动脉狭窄组血清Cys　C、同型半胱氨酸高于非狭窄组（P<0.01）。Spearman相关分析发现颈动脉狭窄与年龄、Cys　C、同型半胱氨酸、尿酸、高血压、糖尿病呈正相关（P<0.05）,Logistic回归分析显示血清Cys　C并非颈动脉狭窄的独立危险因素,而年龄、高血压、糖尿病为颈动脉狭窄的独立危险因素。各亚组间分析发现,重度狭窄组Cys　C水平较非狭窄组显著升高（P<0.05）;重度狭窄组Cys　C水平较轻度狭窄组、中度狭窄组升高,差异有统计学意义（P<0.01,P<0.05）。Logistic回归分析发现Cys　C、甘油三酯、高血压为颈动脉重度狭窄的独立危险因素（P<0.05）。结论　血清Cys　C水平与颈动脉重度狭窄相关,为颈动脉重度狭窄的独立危险因素。     

三维超声血管斑块定量分析技术诊断颈动脉血管狭窄及斑块特征的应用

目的 探讨实时三维超声（real-time 3D ultrasound,RT-3DU）血管斑块定量分析（vascular plaque quantification,VPQ）技术诊断颈动脉血管狭窄及斑块特征的应用。 方法 对2020年1月~2021年1月于新疆医科大学第七临床医学院接受RT-3DU检查的颈动脉斑块患者40例（颈动脉斑块共57处）进行分析,应用RT-3DU VPQ技术检测颈动脉相关参数,同时应用动脉CT血管造影术检测颈动脉狭窄程度,比较分析两种方式诊断颈动脉狭窄程度的一致性。 结果 在40例颈动脉斑块患者中,其颈动脉内中膜厚度为（1.33 ± 0.14）mm,斑块回声强度为（36.29 ± 7.51）dB,标化壁指数（NWI）为（0.64 ± 0.18）,57处颈动脉斑块厚度为（3.6 ± 0.5）mm。轻度、中度及重度狭窄组患者的NWI比较差异显著（P<0.05）,且重度狭窄组患者的NWI高于轻度及中度狭窄组,中度狭窄组患者的NWI高于轻度狭窄组（P<0.05）。RT-3DU VPQ检查诊断颈动脉局部管腔存在9处轻度狭窄,43处中度狭窄,5处重度狭窄;动脉CT血管造影检查诊断颈动脉局部管腔存在6处轻度狭窄,38处中度狭窄,13处重度狭窄。RT-3DU VPQ和动脉CT血管造影检查诊断颈动脉局部管腔狭窄程度的一致性较高（Kappa=0.819）。 结论 对于颈动脉斑块患者,应用RT-3DU VPQ技术可测定其血管狭窄程度,还可量化分析斑块回声强度、累及部位血管负荷变化。     

老年脑卒中患者高同型半胱氨酸血症与颈动脉狭窄的关系

目的研究老年脑卒中患者高同型半胱氨酸血症(HHcy)与颈动脉狭窄的关系。方法选择>60岁的颈动脉系统缺血性脑卒中患者126例行全脑血管造影术,根据造影结果分为轻度狭窄组(52例)、中度狭窄组(46例)和重度狭窄组(28例),另选健康体检者50例为正常对照组。应用微粒子酶联免疫分析法测定同型半胱氨酸(Hcy)。结果颈动脉各狭窄组血清Hcy水平显著高于正常对照组(P<0.01);重度狭窄组血清Hcy水平显著高于中度狭窄组及轻度狭窄组(P<0.01),中度狭窄组显著高于轻度狭窄组(P<0.01)。结论HHcy是动脉粥样硬化的重要危险因素,与颈动脉狭窄的严重程度相关。     

粥样硬化性颅内-外动脉狭窄与冠状动脉狭窄的关系

目的探讨颅内-外动脉粥样硬化性狭窄与冠状动脉狭窄的关系。方法将34例经冠状动脉造影证实为冠状动脉狭窄，并且同时行全脑血管造影的冠心病患者分成两组，A组（冠状动脉狭窄≤2支）18例，B组（冠状动脉狭窄≥3支）16例。比较两组患者颅内动脉（A组：198支，B组176支）、颅外动脉（A组：176支，B组128支）狭窄情况；又比较两组患者颈动脉系统（A组：180支，B组160支）、椎-基底动脉系统（A组：90支，B组80支）狭窄情况。结果①A组患者颅内-外动脉狭窄性病变的检出率分别为4．6％（9／198）及13．2％（19／144）；B组分别为12．5％（22／176）及28．9％（37／128），两组比较差异均有统计学意义（P=0．005，P=0．001）。②A组患者颅内-外动脉狭窄程度分别为：轻度狭窄11支（39％）、中度狭窄9支（32％）和重度狭窄或闭塞8支（29％）；B组分别为13支（22％）、14支（24％）及32支（54％），两组间重度狭窄或闭塞性病变比较，差异有统计学意义（P=0．026）。③A组患者颈动脉系统和椎-基底动脉系统狭窄性病变的检出率分别为8．3％（15／180）和8．9％（8／90）；B组分别为21．9％（35／160）及16．3％（13／80），两组间颈动脉系统狭窄性病变差异有统计学意义（P=0．000）；而椎-基底动脉系统狭窄性病变差异无统计学意义（P=0．147）。结论在冠心病患者中，冠状动脉狭窄程度越重，颅内-外动脉粥样硬化狭窄性病变亦越重，在颈动脉系统表现更加显著。     

Relationship between coronary atherosclerotic stenosis and cerebral atherosclerotic stenosis

To investigate the relationship between severity of cerebrovascular atherosclerosis stenosis and that of coronary atherosclerosis stenosis.Methods Cerebral angiography and coronary angiography were performed in 34 patients who had coronary disease with cerebral ischemia.Patients were divided into 3 subgroups according to the degree ofstenosis on angiography,concomitant diseases,risk factors and biochemical data.Results The follow-up study showed that the incidence of cardiac and cerebrovascular death increased significantly in patients with moderate to severe stenosis of coronary and cerebral arteries;the severity of stenosis in the coronary artery parallels that in the solitary carotid artery,or dual carotid and vertebral arteries.Conclusions Patients with coronary and cerebral artery stenosis,especially those with multi-risk factors,such as hypertension,diabetes and cigarette smoking,should receive intensive treatment to reduce cardiac and cerebrovascular events.(J Geriatr Cardiol 2008;5:227-229)     

脑动脉狭窄分布特征及其危险因素的分析

目的探讨缺血性脑血管病患者的脑动脉狭窄病变的分布,以及与动脉粥样硬化危险因素的关系。方法回顾性分析377例经脑血管造影检查的脑缺血患者的临床资料,由两名神经科医师分别对血管狭窄病变的部位、程度进行统计,并按照病变发生的部位及程度,分为单纯颅内动脉病变组、单纯颅外动脉病变组、重度狭窄及闭塞组以及多发性血管病变组,对其动脉粥样硬化的危险因素进行分析。结果（1）377例患者中,存在脑血管病变的患者有285例,共检出病变数892处,其中颅外动脉病变438处（49．1％）,颅内动脉病变454处（50．9％）。前者最常见于颈内动脉颅外段（19．6％,175／892）,后者最常见于颈内动脉颅内段（15．0％,134／892）及大脑中动脉（12．4％,111／892）。②对血管狭窄程度的分析表明,颅外动脉中,以椎动脉及颈内动脉颅外段的狭窄程度最为严重,与颈总动脉比较,差异有统计学意义（P〈0．05）;颅内动脉则以大脑前动脉及大脑中动脉的狭窄程度严重。③单纯颅内动脉病变的患者合并有高血压病的比率较单纯颅外动脉病变者多（80．39％,59．42％）,差异有统计学意义（P=0．015）。存在严重血管病变患者的多项动脉粥样硬化危险因素较造影正常的患者增多。结论缺血性脑血管病患者颅内动脉病变略多于颅外动脉。椎动脉及颈内动脉颅外段、大脑前动脉、大脑中动脉狭窄程度较为严重。单纯颅内动脉病变的患者合并有高血压病的比率较单纯颅外动脉病变者明显增高;动脉硬化危险因素增多,脑血管造影出现血管重度狭窄的概率增大。     

Feasibility and safety of transradial artery approach for selective cerebral angiography.

The transradial artery (TRA) approach is a conventional means of diagnostic cardiac catheterization and catheter-based coronary intervention. However, to our knowledge, the safety and feasibility of cerebrovascular angiographic studies using the TRA approach for patients with brain ischemia has not been reported. This study investigated whether the TRA approach using 6 Fr Kimny guiding catheter for both extracranial and intracranial angiographies is safe and effective for patients with a history of stroke, transient ischemic attack, or significant carotid stenosis. From February 2003 to June 2004, a total of 46 consecutive patients with an age range from 50 to 83 years were enrolled into the study. The retrograde engagement technique that involved lopping the guiding catheter was utilized. Outpatient carotid angiography was performed in 40% of the study patients. The overall procedural success (defined as completely evaluating both carotid and vertebral arteries and intracranial vessels) was 93.5% (n = 43) using the Kimny guiding catheter. Significant cerebrovascular stenosis (> 50%), including carotid artery in 52.2% (n = 24), vertebral artery in 15.2% (n = 7), and intracranial major artery in 15.2% (n = 7), was found in 82.6% of the patients. Notably, 17 (37.0%) of these patients with severe carotid stenosis (> or = 70%) required staged carotid stenting. Concomitant vertebral artery stenting was performed in four (8.7%) patients because of severe stenosis (> or = 70%) of these vessels. Two patients experienced transient dizziness (duration < 30 min) following the procedure. TRA approach for selective cerebral angiography is safe and feasible in patients with a history of brain ischemia.     

老年血脂水平与颈动脉和冠状动脉狭窄关系的临床分析

目的探讨老年人群中血脂水平对颈动脉、冠状动脉(冠脉)狭窄发生的影响。方法选择315例冠脉造影患者,181例年龄≥65岁为老年组、其余<65岁的134例为对照组。同时进行血脂水平测定、冠脉和颈动脉造影;采用定量分析方法对冠脉病变特征,计算冠脉狭窄病变积分,并依据有无血脂异常、冠脉狭窄程度进一步分为不同的亚组。结果老年组与对照组平均年龄为(73.73±5.34)岁、(55.96±6.54)岁,诊断血脂异常分别为53例(29.28%),36例(26.86%)。冠脉病变严重程度积分老年组明显高于对照组(P<0.05),血脂异常亚组的积分明显高于非血脂异常亚组[老年组(7.03±6.65)分vs(6.61±5.73)分,对照组(5.72±5.90)分vs(4.59±5.00)分,P<0.05]。随冠脉狭窄的严重程度的升高、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、脂蛋白(a)、载脂蛋白B的水平相应升高的趋势,而高密度脂蛋白胆固醇、载脂蛋白A1水平则呈现逐渐降低趋势,老年组与对照组无显著差异(P>0.05)。颈动脉狭窄老年组的检出率明显高于对照组(20.99%vs8.20%,P<0.05),血脂异常可增加老年组颈动脉狭窄的发生率(P<0.05),但冠脉病变的轻重程度与颈动脉狭窄的发生无显著关联。结论血脂异常可增加老年人群颈动脉、冠脉狭窄的发生率,血脂异常的程度与冠脉病变的程度呈正相关,冠脉病变的程度与颈动脉狭窄的检出无明显关联。     

Ultrasound assessment of internal carotid disease candidates to endovascular carotid stenting and cardiac surgery is inaccurate in patients with severe aortic valve stenosis

PURPOSE: The association of internal carotid artery disease (ICAD) with aortic valve stenosis (AVS) constitutes a very high-risk clinical occurrence in which combined surgery may increase the operative risks and carotid stenting before or after cardiac surgery may be a valuable option. Unfortunately, in patients with AVS, the evaluation of carotid arteries by Doppler ultrasound (DUS) may be inaccurate. The present retrospective study is aimed to evaluate the pitfalls of DUS and the role of carotid angiography before carotid stenting in evaluating ICAD in patients with AVS. METHODS: We analyzed the clinical, hemodynamic, and angiographic findings of 200 patients with moderate to severe AVS (5.5% of 3600 patients underwent cardiac catheterization; mean age, 68.5+/-10.6 years) investigated in our institution over the past 2 years. Patients with moderate to severe AVS, candidates to open cardiac surgery, underwent carotid ultrasonography to assess ICAD and complete left and right catheterization with coronary artery angiography, and in case of doubtful carotid artery sonography, the patients underwent also carotid artery angiography at the time of complete cardiac catheterization before confirming the indication to carotid stenting or combined surgery. RESULTS: Seventy patients with moderate to severe AVS and doubtful carotid ultrasonography underwent coincident carotid angiography. Reasons for suboptimal Doppler ultrasonographic examination are related to the anatomical or to the difficult evaluation of Doppler flow due to hemodynamic influences of AVS. On carotid angiography, 20 patients (28.5%, male/female, 8/12; mean age, 72.1+/-5.1 years) were diagnosed to have critical stenosis of one (16 patients) or both (4 patients) internal carotid arteries; in five patients, a significant ICAD was not diagnosed by DUS, whereas in seven patients, the stenosis was underestimated by DUS (mean luminal narrowing, 58+/-12.7% vs. 76.7+/-19.3%, P<.03), and in the other eight patients, DUS overestimated ICAD (77+/-12% vs. 62+/- 13.4%, P<.02). Out of this group, six patients underwent successful carotid stenting, six combined surgical treatments, and eight underwent simple cardiac surgery. CONCLUSIONS: Doppler ultrasound may be inconclusive in evaluating ICAD in patients with moderate to severe AVS candidates to cardiac surgery and endovascular carotid stenting. Carotid angiography may be proposed at the time of cardiac catheterization in patients with inconclusive DUS examination.     

Carotid artery involvement in patients of atherosclerotic coronary artery disease undergoing coronary artery bypass grafting

BACKGROUND: Patients with concomitant critical carotid and coronary artery disease are at risk of major neurological events while undergoing coronary artery bypass grafting. The presence of carotid artery stenosis increases the stroke rate in the perioperative period. In an effort to reduce the stroke rate, many institutions perform routine preoperative noninvasive assessment of the carotid arteries. METHODS AND RESULTS: We analyzed the clinical and laboratory data of 1,200 patients who underwent coronary artery bypass surgery in the last 2 years. Carotid Doppler was normal in 186 patients (15.5%), and showed <30% stenosis in 796 (66.3%), 30%-50% in 110 (9.2%), 50%-70% stenosis in 64 (5.3%) and critical (>70%) stenosis in 44 (3.7%) patients. Conventional risk factors such as hypercholesterolemia, hypertension, smoking and family history were not independent predictors of carotid artery stenosis. However, diabetes as a risk factor had a significant association with carotid artery disease (79.6% v. 43.8%, p<0.02). There was a trend towards increased prevalence of carotid artery stenosis in patients with > or = 2 risk factors (84.3% v. 68.8%). Patients with significant carotid artery stenosis had severe coronary artery disease (triple-vessel disease 93.3%, left main coronary artery disease 12.0%). Out of 44 patients with critical carotid artery stenosis, 27 were subjected to carotid angiography. Doppler findings correlated well with angiography. Seventeen patients underwent carotid artery intervention. None had any perioperative neurological events. A total of 5 (0.4%) patients had a major stroke. Coronary artery bypass grafting was done in 27 patients with critical stenosis without any intervention. The stroke rate (11.1%) was higher in these patients compared to patients with < 70% carotid artery disease or post-carotid intervention (2.5%) patients. Thus, untreated >70% carotid artery stenosis was associated with a higher stroke rate. CONCLUSIONS: Doppler screening of the carotid artery is helpful in detecting the subgroup of patients at increased risk of stroke. Patients with critical carotid artery stenosis should be subjected to angiography. Prophylactic intervention may reduce the occurrence of stroke in the perioperative period.     

睡眠呼吸暂停低通气综合征与脑供血动脉狭窄的相关性研究

目的 深入研究脑供血动脉的狭窄部位与睡眠呼吸暂停低通气综合征(sleep apnea-hypopnea syndrome,SAHS)的关系,进一步探讨SAHS与缺血性脑血管病并存的机制.方法 选取53例全脑数字减影血管造影证实的脑供血动脉狭窄患者,将其按脑供血动脉狭窄部位分为两组,所有患者进行多导睡眠图监测并将监测结果进行比较.结果 53例脑血管供血动脉狭窄患者中并发SAHS者30例(56.6%).Ⅱ组(椎-基底动脉系统血管狭窄)患者SAHS的发生率较Ⅰ组(颈内动脉系统血管狭窄)患者高,且更容易出现阻塞型和中枢型呼吸暂停事件.结论 脑供血动脉狭窄患者具有较高的SAHS发生率,SAHS与脑供血动脉狭窄的密切关系不容忽视;椎-基底动脉系统脑供血动脉狭窄患者更容易发生SAHS,更容易出现阻塞型和中枢型呼吸暂停事件.     

颅内外动脉重度狭窄或闭塞患者的侧支循环途径

目的探讨颅内外动脉重度狭窄或闭塞患者的侧支循环途径。方法对100例老年颅内外动脉重度狭窄或闭塞患者,采用经颅多普勒超声(TCD)技术评估侧支循环变化。结果大脑中动脉主干重度狭窄或闭塞59例,TCD显示软脑膜吻合侧支通路开放34例,占57.6%。颈内动脉起始部重度狭窄或闭塞30例,侧支通路开放24例,占80.0%,其中前动脉交通侧支开放8例,后动脉交通侧支开放2例,前动脉交通与后动脉交通侧支同时开放4例,眼动脉侧支开放6例,前动脉交通、后动脉交通和眼动脉侧支同时开放4例。锁骨下动脉重度狭窄7例,TCD发现窃血改变4例,占57.1%。椎动脉重度狭窄或闭塞3例中,2例椎动脉起始部闭塞患者出现颈外动脉-椎动脉侧支开放。左侧颈总动脉闭塞伴头臂干中度狭窄1例,TCD显示椎动脉-颈外动脉-颈内动脉侧支通路开放。结论 TCD技术有助于了解颅内外动脉重度狭窄或闭塞患者的侧支循环途径。     

Age-dependence of risk factors for carotid stenosis: an observational study among candidates for coronary arteriography.

In order to identify subjects at higher risk for carotid stenosis and to provide insights into mechanisms of disease development at different age-intervals, a color duplex ultrasound of extracranial arteries was performed in 624 consecutive patients (mean age 62.9+/-10.7, 483 males) undergoing coronary angiography. Significant carotid atherosclerosis (> or =50% stenosis) was documented in 87 patients (14%): the disease was moderate (50/69% stenosis) in 51 patients (8%), severe (> or =70% stenosis) in 36 patients (6%). Age (P<0.0001), smoking (P<0.0001), diabetes (P=0.0002), renal dysfunction (P=0.0119) and hypertension (P=0.0202) were independent predictors of significant carotid atherosclerosis; age (P=0.0001), smoking (P=0.0009) and diabetes (P=0.0201) were independent predictors of severe disease. Among 262 candidates for cardiac surgery, significant carotid artery disease was identified in 57 cases (2.63 Relative Risk, 95% Confidence Intervals: 1.32/5.24). Correlation and regression tree analysis demonstrated that diabetes was associated with greater severity of carotid stenosis in younger patients and hypertension in older ones. In conclusion age is the primary determinant of carotid artery disease; diabetes and smoking accelerate progression of atherosclerosis in younger patients, hypertension and smoking in older ones. Among patients undergoing coronary angiography, carotid ultrasonography should be recommended in high risk subgroups of patients.