缺血性脑血管病患者脑动脉狭窄的分布

目的探讨不同年龄缺血性脑血管病患者脑动脉狭窄的分布规律。方法缺血性脑血管病患者340例行全脑血管造影,其中短暂性脑缺血发作(TIA)患者105例(TIA组),脑梗死患者235例(脑梗死组);又根据年龄分为青年组(54例)、中年组(137例)、老年组(149例)。结果脑梗死组吸烟、饮酒明显高于TIA组(P<0.05);老年组颈动脉狭窄、颅外动脉狭窄高于中年组和青年组,中年组高于青年组(P<0.05);青年组颅内动脉狭窄高于颅外动脉狭窄,老年组颅外动脉狭窄高于颅内动脉狭窄(P<0.05);缺血性脑血管病和脑梗死患者前循环动脉狭窄高于后循环(P<0.01);老年组前后循环及后循环动脉狭窄明显高于中年组和青年组(P<0.01);中年组前后循环及后循环动脉狭窄高于青年组(P<0.01)。结论动脉粥样硬化性缺血性脑血管病患者脑动脉狭窄的分布有疾病和年龄特征性。     

颈内动脉系统短暂性脑缺血发作患者脑动脉狭窄的分布特征

目的通过数字减影血管造影检查,研究颈动脉系统短暂性脑缺血发作与颅内外供血动脉狭窄的关系。方法对251例颈内动脉系统短暂性脑缺血发作患者的全脑血管造影术资料进行分析,计算颅内外血管狭窄发生率,对不同年龄组患者颅内外血管狭窄情况进行统计学比较。结果 251例颈内动脉系统短暂性脑缺血发作的患者,有248例检出了脑动脉狭窄,占98.8%。共检出病变血管688支,前循环病变587支(85.3%),后循环病变101支(14.7%)。青年组颅内动脉狭窄高于颅外动脉,老年组颅外动脉狭窄高于颅内动脉,老年组颅外动脉狭窄高于中年组和青年组,中年组颅外动脉狭窄高于青年组。结论本研究资料提示,前循环动脉狭窄为颈内动脉系统短暂性脑缺血发作的主要原因。不同年龄患者脑动脉狭窄的空间分布明显不同。     

短暂性脑缺血发作患者病变血管分布及特征

目的探讨短暂性脑缺血发作(TIA)患者的病变血管分布及特征。方法选取2011年1月~2015年12月间于北京市平谷区医院住院的TIA患者102例,其中男性49例,女性53例;年龄20~81岁,平均年龄(59.7±6.3)岁。依据年龄分为青年组(18~45岁,26例)和中年组(46~60岁,25例)、老年组(60岁,51例)。数字减影血管造影分析患者颅内外动脉血管狭窄及分布特征。结果本研究102例TIA患者中,血管造影检查结果显示阳性90例,占总人数的88.2%(90/102)。颅内外动脉血管狭窄或闭塞146处,其中颅内动脉血管狭窄82处,占56.2%(82/146),包括轻度狭窄14处,中度狭窄22处,重度狭窄29处,闭塞17处;颅外动脉血管狭窄64处,占43.8%(64/146),包括轻度狭窄18处,中度狭窄11处,重度狭窄25处,闭塞10处。颅内动脉血管狭窄以大脑中动脉最常见,颅外动脉血管狭窄以颈内动脉颅外段最常见。动脉血管狭窄患者90例,其中颅内动脉血管狭窄41例,占总人数的40.2%;颅外动脉血管狭窄9例,占8.8%;颅内外均有狭窄40例,占39.2%。青年组颅内动脉血管狭窄率明显高于老年组(65.4%vs.25.5%),颅外动脉血管狭窄率明显低于老年组(3.8%vs.11.8%),差异有统计学意义(P均0.05)。与青年组比较,中年组和老年组颅内外动脉均狭窄的比例明显升高,差异有统计学意义(P均0.05)。相关分析显示,TIA患者年龄与颅内动脉狭窄程度之间呈负相关关系(r=-0.712,P0.05),与颅外动脉狭窄程度之间呈正相关关系(r=0.647,P0.05)。结论短暂性脑缺血发作患者多数存在颅内外动脉狭窄,患者颅内动脉狭窄比例较颅外高,且狭窄程度与年龄存在一定关联。     

306例缺血性脑血管病患者脑动脉狭窄特点分析

目的为缺血性脑血管病患者脑动脉狭窄的临床防治提供依据。方法筛选经数字减影血管造影（DSA）检查证实存在脑动脉狭窄的缺血性脑血管病患者306例,根据年龄分为青、中、老年组,对其颅内外动脉的狭窄程度、分布特征及特点等进行比较。结果单纯颅内动脉狭窄128例、单纯颅外动脉狭窄78例,单纯前循环动脉狭窄142例、单纯后循环狭窄63例,单支性血管狭窄者96例、多发性狭窄者210例;老年组单发性血管狭窄占23.28%,明显低于中年组（17.87%）和青年组（7.36%）,P〈0.01;青年组颅内动脉狭窄占83.62%,明显高于中年组（44.79%）和老年组（28.30%）,P〈0.01;老年组前循环狭窄占31.45%,明显低于青年组（74.51%）和中年组（56.25%）,P〈0.01。结论缺血性脑血管病患者颅内外动脉狭窄的分布具有年龄差异,早期对相关因素进行干预有利于降低缺血性脑血管病的发病率。     

64层CT对缺血性脑血管病患者脑动脉狭窄分布特征的研究

目的探讨动脉粥样硬化性缺血性脑血管病患者颅内外动脉狭窄的部位和年龄分布特征。方法选择存在脑动脉狭窄的缺血性脑血管病患者144例,按年龄分为青年组(18～44岁,12例)、中年组(45～59岁,45例)和老年组(≥60岁,87例)。通过CT血管造影检查,对脑动脉不同狭窄部位及年龄分布特征进行分析。结果 144例动脉狭窄或闭塞患者中,共检测到病变血管414支,单支性血管狭窄24例(16.7%),多发性狭窄120例(83.3%,P<0.01)。单纯颅内动脉狭窄和颅内合并颅外动脉狭窄发生率明显高于单纯颅外动脉(60.4%vs 31.3%vs8.3%,P<0.01)。颅内、外动脉病变好发部位依次为:大脑中动脉和椎动脉颅外段。单纯前循环狭窄和前后循环均狭窄发生率明显高于单纯后循环狭窄(35.4%vs 41.7%vs 22.9%,P<0.05,P<0.01)。青年组和中年组单纯颅内动脉狭窄发生率明显高于老年组(83.3%vs 75.6%vs 49.4%,P<0.05)。老年组单纯颅外动脉狭窄发生率明显高于中年组(12.6%vs 2.2%,P<0.05)。结论缺血性脑血管病患者脑动脉狭窄以多发性为主;颅内动脉狭窄的发生率高于颅外动脉;脑动脉狭窄分布有随年龄变化的特征性。     

120例颅内外脑供血动脉严重狭窄或闭塞患者全脑血管造影分析

目的 探讨颅内外脑供血动脉狭窄或闭塞患者的全脑血管造影特点.方法 对经全脑血管造影证实的120例颅内外脑供血动脉严重狭窄或闭塞病例的血管造影资料进行分析.根据年龄将患者分为青年组(6～44岁,48例)、中年组(45～59岁,41例)和老年组(≥60岁,31例).结果 全组病例共有狭窄或闭塞324处,单纯颅内动脉狭窄占47%,显著高于单纯颅外动脉狭窄占35%和颅内外狭窄并存占18%.青年组单纯颅内动脉狭窄比例为79%,显著高于中年组(29%,P<0.01)和老年组(19%,P<0.01);青年组单纯颅外血管狭窄比例为10%,显著低于中年组(46%,P<0.01)和老年组(58%,P<0.01);青年组前循环狭窄比例为97%,显著高于中年组(75%,P<0.01)和老年组(56%,P<0.01).脑梗死患者单纯颅内动脉狭窄占35%,单纯颅外动脉狭窄占42%,颅内外动脉狭窄并存占23%;短暂性脑缺血发作(transient ischemic attack,TIA)患者单纯颅内动脉狭窄占44%,单纯颅外动脉狭窄占39%,颅内外动脉狭窄并存占17%.82%的脑(室)出血发生于单纯颅内动脉狭窄患者.共107例患者存在梗死灶,其中99例梗死灶与动脉狭窄部位存在相关性.部分患者存在高血压、吸烟、高脂血症、高龄和糖尿病等危险因素,与狭窄分布模式有一定关系.结论 脑供血动脉狭窄的最多发部位是颈内动脉.单纯颅内动脉狭窄以青年人多见,随年龄的增长颅外动脉狭窄比例逐渐增高,颅内外动脉狭窄并存情况逐渐增多,前循环狭窄比例逐渐降低,而后循环狭窄比例逐渐升高.脑梗死、TIA和脑(室)出血患者动脉狭窄好发部位各不相同.缺血性脑血管病患者梗死灶与动脉狭窄部位密切相关.高血压对患者形成颅内外动脉狭窄影响最大,高龄和糖尿病对颅外动脉狭窄影响较大.     

缺血性脑血管病患者脑动脉狭窄的分布及特征

目的　探讨动脉粥样硬化性缺血性脑血管病患者脑动脉狭窄的分布特征。方法　选择连续行主动脉弓 +全脑血管造影检查的成年缺血性脑血管病患者 196例 ,将其中 171例存在脑动脉狭窄的患者按年龄分为青年组 (18～4 4岁 )、中年组 (45～ 5 9岁 )及老年组 (≥ 6 0岁 ) ,分析脑动脉狭窄随年龄变化的分布规律。结果　 171例脑动脉狭窄的患者中颅内动脉狭窄的发生率 (80 .7% )明显高于颅外动脉 (5 6 .1% )。青年组单纯颅内动脉狭窄的比例较高 ,主要发生在大脑中动脉。中年组及老年组颅内、外动脉狭窄并存的比例较高。颅外动脉病变数目随年龄不断增加(P <0 .0 0 1)。结论　动脉粥样硬化性缺血性脑血管病患者颅内动脉狭窄的发生率高于颅外。脑动脉狭窄的分布有年龄特征性     

缺血性脑血管病患者数字减影血管造影回顾分析

目的探讨缺血性脑血管病患者颅内外动脉狭窄或闭塞的分布特征及侧支循环开放情况。方法收集166例数字减影血管造影检查确诊为颅内外动脉狭窄或闭塞的缺血性脑血管病患者的临床资料,按年龄分为青年组11例、中年组67例和老年组88例,记录其动脉狭窄及侧支循环开放情况。结果 166例患者中,30.1%有颅内病变,39.8%有颅外病变,30.1%颅内外病变并存;颅外动脉狭窄或闭塞以颈内动脉居多,颅内动脉狭窄或闭塞以大脑中动脉最明显;与青年组比较,中年组、老年组颅内动脉狭窄率明显降低(P<0.01),颅内外动脉狭窄并存比例明显升高(P<0.05)。61例颅内外动脉重度狭窄或闭塞患者存在侧支循环,其中颈内动脉狭窄或闭塞代偿形式以初级侧支循环开放为主,占67.7%,大脑中动脉以次级侧支循环开放为主,占72.2%。结论随着年龄的增长,颅外动脉病变的比例逐渐增高。颅内外大动脉严重狭窄或闭塞时存在3级侧支循环的开放。     

青年缺血性卒中患者脑动脉狭窄的分布特点及病因分析

目的探讨青年缺血性卒中患者脑动脉狭窄的发生率、分布特点及可能的病因。方法回顾性纳入217例发病≤2周的缺血性卒中患者,分为青年组(18~45岁,106例)及中年组(46~55岁,111例)。比较青年组与中年组脑动脉狭窄的发生率及分布情况,并对伴有脑动脉狭窄患者的危险因素及病因进行分析。结果 (1)青年组脑动脉狭窄的发生率为69.8%(74/106),中年组为78.4%(87/111),差异无统计学意义(P0.05)。(2)青年组与中年组脑动脉狭窄在颅、内外分布差异无统计学意义,均以颅内动脉狭窄为主[分别为75.7%(56/74)和62.1%(54/87)]。青年组前循环狭窄发生率为71.6%(53/74),高于中年组的41.4%(36/87);中年组前、后循环均有狭窄的发生率为20.7%(18/87),高于青年组的8.1%(6/74),P均0.05。青年组单纯大脑中动脉狭窄发生率为58.9%(33/56),高于中年组的27.8%(15/54),P0.05;中年组椎动脉及基底动脉狭窄发生率为27.8%(15/54),高于青年组的12.5%(7/56),P0.05。(3)中年组脑动脉狭窄患者中,高血压、糖尿病、冠心病及饮酒者所占的比例高于青年组,P0.01或P0.05。中年组动脉粥样硬化性狭窄发生率高于青年组[93.1%(81/87)对比64.9%(48/74),P0.01],青年组不明原因的血管狭窄比例高于中年组[23.0%(17/74)对比2.3%(2/87),P0.01]。非动脉粥样硬化病因中,青年组动脉夹层、烟雾病及血管炎发病率更高,但差异无统计学意义。结论青、中年卒中患者脑动脉狭窄发生率相近;青年卒中脑动脉狭窄以前循环为主,单纯大脑中动脉狭窄发生率高;动脉粥样硬化性狭窄的相关危险因素较少,而不明原因比例较高。     

脑梗死患者急性期全脑血管造影的临床分析

目的分析脑梗死患者急性期全脑数字减影血管造影术(DSA)的资料,探讨颅内外动脉病变的性质、程度及范围特点。方法选择脑梗死患者207例,按年龄分为老年组(≥60岁,116例)和非老年组(<60岁,91例),患者均进行主动脉弓+全脑DSA,分析血管狭窄的程度和部位及年龄变化的规律。结果 DSA显示148例(71.5%)患者共413处血管狭窄,其中颅外动脉狭窄211处(51.1%),颅内动脉狭窄202处(48.9%),颅外动脉狭窄以颈内动脉颅外段多见,颅内动脉狭窄以大脑中动脉多见。老年组患者颅内合并颅外动脉狭窄的比例46.7%,明显高于非老年组的26.7%,差异有统计学意义(P<0.05)。结论 DSA能显示脑梗死患者颅内外动脉狭窄分布的规律,有助急性脑梗死的治疗,以降低脑梗死的复发率。     

Lumbar and cervical stenosis. Frequency of the association,role of the ankylosing hyperostosis

Summary The authors report a study of 47 patients admitted for cervical myelopathy (N=17) or symptomatic lumbar spinal stenosis (N=30). Nine patients had clinical evidence of coexisting cervical myelopathy and lumbar spinal stenosis. Ten out of the 17 patients having cervical myelopathy had lumbar spinal stenosis as evidenced by saggital tomography and/or computerized tomography. Nine out of the 30 patients admitted for symptomatic lumbar spinal stenosis had coexisting cervical canal stenosis as evidenced by sagittal tomography. Thirteen out of these 19 patients with both cervical and lumbar canal stenosis had also ankylosing spinal hyperostosis.     

Subvalvular aortic stenosis: a review of current literature

Subvalvular aortic stenosis (SAS) is one of the common adult congenital heart diseases, with a prevalence of 6.5%. It is usually diagnosed in the first decade of life. Echocardiography is the test of choice to diagnose SAS. Surgical correction is the best treatment modality, and the prognosis is usually excellent. In this review, we describe the pathophysiology, diagnosis, prognosis, and management of SAS with a focus on different pathophysiologic mechanisms, diagnostic approach, and prognosis of the disease by reviewing the current literature.     

Isolated bilateral ostial coronary stenosis with proximal right coronary artery occlusion

The incidence of coronary ostial stenosis in patients undergoing coronary arteriography has been found to range between 0.07 and 0.25%. A slightly higher incidence has been observed in patients with angiographically confirmed coronary artery disease: between 0.13 and 2.7%. Bilateral ostial stenosis is even less common. longer a prominent condition, it must be considered in the differential diagnosis since it carries a very high risk (50%) of cardiovascular complications if left untreated. Ostial coronary stenosis occurs in 26% of patients with syphilitic aortitis. This paper reports on a 41-yearold Wasserman (WR)-positive woman with progressive angina caused by bilateral ostial coronary stenosis. (Int J Cardiovasc Although cardiovascular syphilis is no Intervent 2000; 3:47–49)     

中风危险度和颈动脉阈狭窄

严重的颈动脉狭窄可导致缺血性脑血管病,但二者是否存在正比关系,尚且不明。本文自1982年起,对500名无症状颈部杂音患者进行前瞻性研究,平均随访52个月,分析缺血性中风发病率与颈动脉狭窄程度以及狭窄是否进展加重的关系,发现首次颈部多普勒检查时的颈内动脉狭窄程度的频率分布呈双峰型,双峰的结合部85％颈动脉狭窄,而且缺血性中风的最高发病率在75～90％颈动脉狭窄的病人,具有统计学意义,说明对75～90％颈内动脉狭窄的无症状病人应采取预防性治疗措施。     

复发性多软骨炎致气道狭窄一例

患者 ,男性 ,30岁。因声嘶 15月 ,加重伴吸气性呼吸困难半年于 2 0 0 0年 5月 2 4日入院。患者于 1998年 12月无明显诱因出现左耳廓红肿痛 ,无化脓及破溃。在当地医院予先锋Ｖ及先锋必抗炎治疗 ,2～ 3个月后红、肿、痛渐消退。于 1999年 2月出现声嘶 ,不伴咽痛、咳嗽、呼吸困难。在当地和外地多家医院以咽喉炎治疗无好转。同年 7月发现鼻梁塌陷 ,11月出现吸气性呼吸困难 ,喉部喘鸣音 ,轻微活动即感胸闷、气短。在当地以哮喘治疗无好转。既往患者身体健康。查体 :左侧耳廓下部较右侧略增大 ,鼻梁塌陷成鞍鼻。喉部及双上肺可闻及吸气性哮鸣音 …     

Low rates of clinical restenosis with the new flexible stainless steel tube intracoronary stent: the R Stent. A six-month safety and feasibility study

BACKGROUND: Coronary stents have been used with increasing frequency and in increasingly complex coronary lesions for the treatment of symptomatic coronary artery disease. A new stainless steel coronary stent, the R Stent, has been designed to provide maximum flexibility for tracking and high radial strength postdeployment. AIMS: To assess the safety and feasibility of the R Stent in patients with coronary artery disease. Specific objectives were to assess the R Stent's deployment success, angiographic and procedural success (< 20% residual stenosis and TIMI 3 flow), safety (absence of complications), 30-day and six-month clinical follow-up. METHODS: Between April 1998 and January 1999, stent deployment was attempted in 36 lesions in 30 patients with stable (43%) or unstable (57%) angina pectoris and 29/36 of the lesions were anatomically complex. Treated lesions were in the LAD ( n = 15), RCA ( n = 13) or LCX ( n = 8). RESULTS: Stent deployment was achieved in 97% with one crossing failure in a patient with a long, calcified, proximal LAD lesion. After the procedure, patients were scheduled for one- and six-month clinical follow-up. One patient experienced a non-Q-wave myocardial infarction in hospital. At one month, there were no additional complications. Only one patient experienced recurrence of angina (CCS class 2) within the 30 days. At six-month follow-up, one sudden death had occurred. Three (10%) patients had anginal complaints, one of them received target lesion repeat PTCA. All other patients (87%) were event- and angina-free. CONCLUSION: This first clinical experience with the R Stent shows acceptable feasibility and safety with good long-term clinical results. (Int J Cardiovasc Intervent 2000; 3: 91-95)     

动脉粥样硬化性肾动脉狭窄的发生率及其相关危险因素分析

目的 对疑似冠心病或急性、慢性心肌梗死的患者进行冠状动脉造影及肾动脉造影,分析动脉粥样硬化性肾动脉狭窄的发生率及其相关危险因素.方法 对279例接受冠状动脉造影的患者进行腹主动脉数字减影血管造影检查.结果 279例患者中,动脉粥样硬化性肾动脉狭窄(≥30%)发生率为28.7%;经冠状动脉造影证实的175例冠心病患者中,肾动脉狭窄(≥30%)的发生率为34.3%;冠状动脉造影完全正常的104例患者中,20例有肾动脉狭窄,冠状动脉多支病变发生肾动脉狭窄的机率增加;多因素Logistic回归分析显示,吸烟、脉压、血肌酐及冠状动脉狭窄积分是动脉粥样硬化性肾动脉狭窄的相关预测因素.结论 对冠心病合并高血压的患者,冠状动脉造影时应常规进行腹主动脉造影检查,以尽早发现动脉粥样硬化性肾动脉狭窄.     

老年冠心病患者血浆Klotho水平测定的临床意义

目的探讨老年冠心病患者血浆Klotho蛋白测定的临床意义。方法随机选取60岁以上的老年住院患者,根据冠状动脉造影或冠状动脉CTA结果分为冠心病组138例(根据病变冠状动脉数目又分为单支病变组和多支病变组两个亚组)和对照组(140例),分别对各组进行血浆Klotho蛋白检测,并对冠心病组患者的冠状动脉狭窄程度与其血浆Klotho蛋白水平进行相关性分析。结果冠心病组患者血浆Klotho蛋白水平显著低于对照组,多支病变组患者血清Klotho蛋白水平低于单支病变组。冠心病组患者的冠状动脉狭窄程度与血浆Klotho蛋白水平呈负相关。结论血浆Klotho蛋白水平一定程度上可以反映冠状动脉狭窄程度,其可以作为评价冠状动脉狭窄程度的指标之一。     

Late outcomes after interventional treatment – Successful stenting of Takayasu arteritis lesions. Single center experience in Bulgaria

AimThe studied group included patients at different age and gender with follow-up period at least 1 year. The work represents endovascular treatment of patients with different localization of the disease and according to the target lesion proper endovascular access was selected.Methods and resultsThe patients are divided into groups, depending on the Numano classification. Seven of studied patients were in age between 33 and 44 years, only 1 was 65 years old, 7 of them were females and 1 male. The patients were accumulated for the period of 1 year.Doppler sonography was used for screening of the patients with known Takayasu disease. Treated lesions were as follows: left subclavian artery – 3 patients, right subclavian artery – 1 patient, right common carotid artery – 1 patient, brachiocephalic trunk – 1 patient, superior mesenteric artery – 2 patients, both external iliac arteries – 1 patient, LAD – 1 patient. Endovascular access of choice were right femoral, right radial, left radial, and right brachial. The used devices were balloon-expandable stents, self-expandable stents, DES/coronary/, PTA only – DCB.ConclusionsAll Takayasu patients in our report were successfully treated with implantation of different types of stents. One year results showed no significant restenosis, except in 1 patient with early restenosis until 6th month.