螺旋CT血管造影与颈部血管超声对急性脑梗死患者动脉系统检测结果比较

目的探讨螺旋CT血管造影(SCTA)与颈部血管超声(CVUS)对急性脑梗死患者颈动脉检查的临床价值。方法选取2010—2014年收治的急性脑梗死患者102例,均进行SCTA、CVUS检查,对比2组患者颈动脉情况。结果 102例脑梗死患者中颈动脉狭窄检出率为80.39%(82/102),颈动脉狭窄率两种检查方法无显著差异(P0.05),SCTA颈动脉斑块检出率为58.81%,相比CVUS显著提高(P0.05)。两种检查方式轻中度颈动脉狭窄无显著差异,3例患者SCTA检查为颈动脉闭塞,CVUS检查为中度狭窄。结论 SCTA与CVUS检查颈动脉血管狭窄具有较高的一致性,SCTA评价颈动脉闭塞具有更高的准确性。     

颈动脉狭窄对老年患者认知功能影响的随访研究

目的 探讨颈动脉狭窄对老年患者认知功能的影响. 方法 在第三军医大学大坪医院住院部和门诊患者中经简明智能状态量表(MMSE)筛选认知功能正常的老年患者215例,通过颈颅联合CT血管造影(CTA)和(或)数字减影脑血管造影(DSA)等方法 ,确定有无颈动脉狭窄和狭窄程度.分颈动脉重度狭窄(狭窄率≥70%)组.颈动脉中度狭窄(狭窄度30%～69%)组,颈动脉轻度狭窄(狭窄度10%～29%)组和基本正常组(狭窄度<10%),1年后采用MMSE检测认知功能及其损害,比较不同颈动脉狭窄组患者认知损害的发生情况以及认知功能下降程度. 结果 经过1年随访,颈动脉重度狭窄患者认知损害发生率(43.1%)高于颈动脉中度狭窄组(22.8%)、颈动脉轻度组(8.3%)和颈动脉基本正常组(8.7%),差异有统计学意义(P<0.05).各组MMSE评分均降低,其中颈动脉重度狭窄组MMSE评分(19.85±7.54)低于颈动脉中度狭窄组(22.71±5.73)、颈动脉轻度狭窄组(25.32±4.22)和颈动脉基本正常组(25.25±4.36),差异有统计学意义(P<0.05). 结论 颈动脉狭窄可导致老年人认知功能损害的发生.并且认知功能损害随颈动脉狭窄程度加重而加重.     

颈动脉支架成形术对认知功能的影响

目的 观察缺血性卒中患者颈动脉支架成形术（CAS）对患者认知功能的影响。方法 116例颈动脉狭窄患者行颈动脉支架成形术,在支架置入前及置入后1、3、6个月应用简易精神状态检查量表（MMSE）、P300观察认知功能的变化,同时对患者卒中的复发进行登记。结果 所有患者均成功置入支架,围手术期无手术相关的并发症;支架置入前颈动脉的狭窄率为84%±15%,支架置入后颈动脉狭窄率为4.5%±6.0%,明显缩小;支架置入前患者的MMSE评分及P300潜伏期分别为20±5和434±78 ms,在治疗后随访的1、3及6个月,MMSE明显提高而P300明显缩短;而且随随访时间延长,P300及MMSE变化越明显;在随访期内患者无症状性卒中复发。结论 颈动脉狭窄是导致认知功能障碍的原因之一,CAS可以改善患者的认知功能。     

Clinical significance of asymptomatic neck bruits

The value of neck bruits as indicators of underlying carotid artery disease was assessed by correlating the results of carotid Doppler examination with auscultation in 336 patients with asymptomatic bruits. Also, the separate findings of auscultation by two physicians were compared for agreement in the quality and location of the bruits. Levels of agreement between the physicians in the clinical examination were acceptable for the presence and site of the neck bruits, but were unacceptable for the intensity, pitch, and duration. Unilateral bruits in the upper neck indicated underlying internal carotid artery (ICA) stenosis detectable by carotid Doppler (greater than 35% stenosis) in 61%, whereas only 11% of patients with bruits localized to the supraclavicular area had ICA stenosis. "Silent" contralateral ICA stenosis was detected by Doppler in 28% of patients with unilateral cervical bruits. Bilateral cervical bruits were the most powerful predictors (76%) of underlying ICA stenosis detectable by Doppler. Neck bruits are valuable indicators of underlying carotid artery disease, but Doppler ultrasound examination adds significantly to clinical accuracy.     

彩色多普勒超声检查对颈部动脉狭窄的诊断价值

目的 研究彩色多普勒超声检查对颈部动脉狭窄的诊断价值.方法 对145例缺血性脑血管病患者进行颈部动脉彩色多普勒超声及数字减影血管造影(DSA)检查.以DSA检查结果为标准,分析彩色多普勒超声检查对颈部血管狭窄的敏感性和特异性.结果 本组患者彩色多普勒超声检查对诊断颈动脉分叉部狭窄的敏感性和特异性分别为96.8%和80.6%,对锁骨下动脉狭窄为60.0%和98.7%,对椎动脉狭窄为33.3%和89.0%.彩色多普勒超声检查诊断颈动脉分叉部、锁骨下动脉和椎动脉狭窄的准确度为93.0%、92.8%和82.1%.结论 彩色多普勒超声检查可作为诊断颈动脉分叉部位血管狭窄的有效方法;而其对锁骨下动脉及椎动脉狭窄的敏感性较低,诊断价值不大.     

复合手术技术治疗复杂颈动脉狭窄和闭塞性疾病简

目的分析复合手术技术在复杂颈动脉狭窄或闭塞性疾病中的应用,探讨其临床意义。方法回顾分析12例因颈动脉闭塞和颈动脉串联性病变施行复合手术患者之临床资料,初步分析手术安全性和有效性。结果8例颈动脉闭塞患者,7例实现血管再通;4例颈动脉串联性病变患者,均实现血管再通。术后无一例发生脑卒中或死亡。结论采用复合手术技术治疗颈动脉闭塞和串联性病变疗效安全可靠,值得在临床推荐开展。     

缺血性脑卒中患者动脉粥样硬化分布的临床研究

目的探讨急性缺血性脑卒中不同亚型与颈动脉粥样硬化分布的相关性。方法通过经颅多普勒超声(TCD)和颈动脉彩色多普勒血流成像(CDFI)方法检测颅内、外动脉粥样硬化程度,并结合病史、生化指标及影像学提示的病变部位进行综合分析。结果411例急性缺血性脑卒中患者,颅内动脉狭窄率为38.93%(160/411),颈动脉颅外段狭窄率24.09%(99/411)。颈动脉颅外段狭窄者年龄大、吸烟比例高,与无狭窄者比较差异有统计学意义(P=0.020,0.013);而颅内动脉狭窄者糖尿病发病率明显高于无狭窄者(P=0.005)。411例中皮质梗死49例、皮质下梗死108例、腔隙性梗死72例和短暂性脑缺血发作30例,颈动脉颅外段狭窄者以皮质梗死为主(P=0.001),并且动脉内-中膜层厚度明显增加(P=0.020);而颅内动脉狭窄者以腔隙性梗死更多见(P=0.016)。颅内、外动脉狭窄者的年龄、性别、血糖及血脂之间差异无统计学意义(均P>0.05)。结论临床和影像学检查所确定的急性缺血性脑卒中亚型与颅内、外动脉粥样硬化的病变部位相关,提示发病的原因可能不同。糖尿病与吸烟是引起颅内、外动脉病变的重要原因。     

烟雾病的MSCTA分析研究

目的进一步提高对烟雾病的理解和认识。方法收集本院30例证实为烟雾病患者MSCTA影片(包括原始轴位影片、VR、MIP、MPR后处理影片),结合脑血管造影结果及文献资料进行分析。结果 30例患者中均有不同程度颈内动脉系统狭窄及闭塞,单侧者10例,双侧者20例;大脑后动脉狭窄或闭塞者9例;大脑后动脉及颈外动脉系统侧支循环形成20例;合并动脉瘤者11例。所有病例均可见异常血管网,部分患者行DSA检查,结果基本一致。结论烟雾病为脑底动脉进行性狭窄、闭塞及广泛侧支循环形成的疾病,它不仅累及颈内动脉系统,还累及椎-基底动脉系统和颈外动脉系统。MSCTA可代替DSA作为烟雾病的首选检查方法。     

颈动脉支架成形术与药物治疗颈动脉狭窄的对比研究

目的 分析颈动脉支架成形术（CAS）与药物治疗颈动脉狭窄的疗效，并评价其安全性。方法 2003年11月至2006年3月采用颈动脉支架成形术治疗颈内动脉狭窄（狭窄率≥50％）21例,于围手术期进行抗血小板治疗及控制危险因素。单纯药物治疗组53例，药物治疗方案同治疗组。临床随访6～28个月。结果 21例手术操作完全成功，术后残余狭窄＜30％，术中3例患者出现一过性心率减慢、血压下降，2例出现颈内动脉远端血管痉挛，治疗后好转；术后未发生新的卒中，颈动脉超声未显示再狭窄。药物治疗组随访期间，5例患者再发卒中，颈动脉超声检查发现14例患者狭窄程度加重，其中2例血管造影证实颈内动脉完全闭塞。结论 与药物治疗组比较，CAS治疗颈内动脉狭窄可以提高患者的生活质量，而且比较安全，短期疗效较好，但有待大样本研究结果证实     

颈动脉内膜剥脱术治疗中重度颈动脉狭窄的临床研究

目的以颈动脉支架置入术(CAS)为对照,分析颈动脉内膜剥脱术(CEA)在治疗中重度颈动脉狭窄的临床价值。方法将100例颈动脉狭窄患者按手术方法不同分为观察组(CEA)和对照组(CAS),记录2组围术期手术相关并发症;记录手术用时、住院时间、治疗费用;随访12个月,记录2组包括死亡在内的不良反应发生率及改良Rankin评分情况。结果观察组与对照组在围术期手术相关并发症、住院时间、术后6个月不良反应发生率及改良Rankin评分比较均无明显差异(P均0.05)。但观察组治疗经费低于对照组(P0.05)。结论颈动脉支架置入术治疗中重度颈动脉狭窄效果良好,术后近期和远期疗效及治疗安全性与颈动脉内膜剥脱术相当,但颈动脉内膜剥离术费用成本较低,并发症少。     

Stroke Prevention-Surgical and Interventional Approaches to Carotid Stenosis

Extracranial carotidartery stenosis is an important cause of stroke that often needs treatment with carotid revascularization. To prevent stroke recurrence, carotid endarterectomy has been well-established for many years in treating symptomatic high- and moderate-grade stenosis. Carotid stenting is an appealing, less invasive alternative to carotid endarterectomy, and several recent trials have compared the efficacy of the 2 procedures in patients with carotid stenosis. Carotid artery stenting has emerged as an important mode of therapy for high-risk patients with symtomatic high-grade stenosis. This review focuses on the current data available that will enable the clinician to decide optimal treatment strategies for patients with carotid stenosis.     

Aberrant Ascending Pharyngeal Artery Mimicking a Partially Occluded Internal Carotid Artery

Doppler sonography has become a primary imaging modality for the diagnosis of carotid arterial stenosis. Carotid stenting for a severely stenotic but not completely occluded carotid artery is becoming an alternative to carotid endarterectomy in selected groups of patients. The authors discuss a case of complete occlusion of the internal carotid artery associated with an ipsilateral aberrant ascending pharyngeal artery originating from the proximal internal carotid artery, which mimicked a stenotic internal carotid artery on sonography. Meticulous Doppler sonographic examination may provide clues for this extraordinary condition, yet angiography is indicated for a definite diagnosis.     

皮质型分水岭脑梗死与颈动脉狭窄的关系及支架置入术后的随访对照研究

目的 探讨皮质型分水岭脑梗死与颈动脉狭窄的关系及支架置入术的治疗效果.方法 23例经MRI或CT确诊的皮质型分水岭脑梗死患者全部行DSA检查;对符合手术指征的11例患者行颈动脉支架置入术(支架组),另12例接受常规治疗(保守组);全部患者随访6-12月.结果 23例皮质型分水岭脑梗死患者除1例无动脉狭窄外,其余均有不同程度颈动脉狭窄.且动脉狭窄程度与临床症状和"盗血"现象的出现存在一定关系(P<0.05);支架组术后即刻动脉狭窄改善90%以上.头晕症状和"盗血"现象消失:随访6-12月后,支架组新增的临床症状、"盗血"和动脉狭窄明显少于保守组,差异有统计学意义(P<0.05).结论 皮质型分水岭脑梗死的发生与颈动脉狭窄存在一定关系:支架置入术对颈动脉狭窄的改善及皮质型分水岭脑梗死的预防有一定临床价值.     

Clinical symptoms of stenosis and occlusion of the carotid arteries

In 174 patients with carotid artery changes confirmed by angiography or autopsy the syndromes of clinical manifestations characteristic of stenosis or occlusion of the internal carotid artery, common carotid artery, external carotid artery were analyzed. Particular attention was given to prodromal symptoms and signs of the disease and non-invasive auxiliary-investigations such as ophthalmodynamometry, ultrasound examination of arteries based on Doppler's phenomenon, and EEG. The role of the effect of its stenosis or occlusion on the condition of patients with associated occlusion of one internal carotid artery are discussed.     

Carotid angioplasty with cerebral protection and stenting: report of 164 patients (194 carotid percutaneous transluminal angioplasties)

BACKGROUND: The introduction of cerebral protection devices with systematic stent placement has changed the nature of carotid artery stenosis treatment, reducing the immediate periprocedural complications and delayed restenosis. METHODS: We treated 164 patients with 194 carotid artery stenosis procedures; 92% of them were symptomatic patients. RESULTS: The morbidity rate of our series was 1.03% and the mortality was 1.9%. CONCLUSIONS: In the future, carotid stenosis treatment should perhaps be performed as a preventative measure and not used as a cure for full-blown symptoms. This could be effective in reducing the morbidity and mortality rates of this pathology.     

高龄老年人症状性颈动脉狭窄与颈动脉内膜切除术(附3例临床报告)

目的　探讨高龄老年人症状性颈动脉狭窄的诊断、狭窄程度与颈动脉内膜切除术的有效性。方法　回顾追踪 3例高龄老年人颈动脉内膜切除术前后临床缺血发作症状、颈动脉超声、头颅及颈部磁共振血管造影的变化。结果　 2例患者经颈动脉内膜切除术后 2、5年内缺血发作缓解 ,颈动脉检查狭窄消失 ,1例患者术后 1个月切除部位形成血栓再次出现狭窄。结论　老年人症状性高度颈动脉狭窄者可从手术中获益。     

缺血性脑血管病患者颈动脉粥样硬化程度与循环内皮祖细胞的相关性分析

目的探讨缺血性脑血管病患者颈动脉粥样硬化程度与循环内皮祖细胞(EPCs)的相关性。方法根据CD133和KDR标记,采用流式细胞仪检测缺血性脑血管病患者(包括TIA、急性脑梗死、颈动脉粥样硬化)和健康体检者外周血内皮祖细胞(EPCs)数量变化。结果缺血性脑血管病患者EPCs数量较对照组明显减少(P<0.01);随着颈动脉粥样硬化程度加重,EPCs数量呈降低趋势,颈动脉重度狭窄与轻度和中度狭窄相比有差异(P<0.05);急性脑梗死和TIA患者较单纯颈动脉粥样硬化患者EPCs数量明显增加(P<0.01)。结论缺血性脑血管病患者EPCs与颈动脉粥样硬化程度呈负相关,可反映颈动脉粥样硬化的程度;急性缺血可能会增加EPCs的动员。     

Carotid artery stenting: results and long-term follow-up

BACKGROUND AND PURPOSE: The role of carotid artery stenting (CAS) as an alternative to carotid endarterectomy in the treatment of for symptomatic carotid artery stenosis is investigated. MATERIALS AND METHODS: Forty-seven patients underwent CAS over 10-year period. Forty-nine vessels were treated. Stenosis quantification was done using North American symptomatic carotid endarterectomy trial method. The mean follow-up period by clinical and Duplex examination ranged is 5.6 years. RESULTS: The technical success rate was 100%. There were four deaths (8.1%) and two (4.1%) minor strokes within thirty days of procedure. There was no major strokes. All patients with minor stroke achieved complete recovery at 1-month follow up. Two deaths occurred probably due to hyperperfusion syndrome (HS) and two due to cardiac arrest. CONCLUSION: CAS is an effective treatment modality of symptomatic carotid artery disease but should be carefully done in high-risk groups having severe medical ailments and those having severe bilateral stenosis of the carotid arteries.     

颈动脉粥样硬化斑块无创性高分辨力磁共振成像研究进展

颈动脉粥样硬化性狭窄与脑卒中复发密切相关。目前颈动脉狭窄的治疗方法主要包括药物治疗和外科手术(颈动脉支架成形术和颈动脉内膜切除术)。脑卒中预防在于识别颈动脉狭窄危险因素,筛查脑卒中复发高危患者,从而使其从药物治疗或外科手术中获益,然而目前仅根据颈动脉狭窄程度制定治疗方案,缺乏个体化治疗。近年来,新型影像学技术如无创性高分辨力磁共振成像(HRMRI)等,可以检测出颈动脉易损斑块。与传统数字减影血管造影术测量的颈动脉狭窄程度相比,无创性HRMRI可以根据颈动脉斑块特征准确预测同侧脑卒中风险,从而指导个体化治疗。     

颈动脉超声对冠状动脉粥样硬化性心脏病合并缺血性脑血管疾病患者颅内动脉狭窄性病变的预测价值

目的探讨颈动脉超声评价冠状动脉粥样硬化性心脏病(CAD)合并缺血性脑血管(ICVD)患者颅内动脉狭窄性病变的预测价值。方法对209例经血管造影证实冠状动脉狭窄(≥70%)同时合并缺血性脑血管疾病的患者采用彩色多谱勒超声(CDFI)和经颅多普勒超声(TCD)分别检查颈动脉和颅内动脉,并将患者分为脑动脉狭窄组与非狭窄组,分别比较两组患者颈动脉超声检查结果中差异有统计学意义的指标。结果颈动脉球部内-中膜(IMT)增厚、不均质回声斑块、多发斑块、颈动脉狭窄与CAD患者合并颅内动脉狭窄性病变之间具有良好的相关关系,(P<0.05)。结论颈动脉内膜增厚、不均质回声斑块,多发斑块、颈动脉狭窄与CAD合并ICVD患者颅内动脉狭窄性病变之间有明显的相关性。采用CDFI对冠状动脉狭窄的患者进行颈动脉检测,在心脑血管事件高危人群中进行筛选,对临床诊断与治疗具有重要的指导意义。