老年脑梗死患者牛津郡社区脑卒中项目分型与危险因素的关系

目的探讨老年脑梗死患者牛津郡社区脑卒中项目(Oxfordshire community stroke project,OCSP)分型与危险因素的关系。方法将来源于南京脑卒中注册项目的478例患者分为完全前循环梗死组(TACI组,79例)、部分前循环梗死组(PACI组,125例)、后循环梗死组(POCI组,111例)和腔隙性脑梗死组(LACI组,163例),分析各危险因素在OCSP亚型中的分布。结果在4组患者中,高血压、高TC血症、吸烟、饮酒、颈动脉狭窄和短暂性脑缺血发作的发生率差异无显著性意义(P>0.05);TACI组发生心房颤动的比例高于LACI组和POCI组(P<0.01),并高于PACI组(P<0.05);LACI组的糖尿病发生率高于其他3组(P<0.05)。高血压合并糖尿病、高血压合并心房颤动、糖尿病合并心房颤动的患者在OCSP亚型间差异无显著性意义(P>0.05)。结论心房颤动与前循环梗死密切相关,糖尿病更多见于LACI。     

进展性缺血性卒中的临床分析

目的探讨不同类型的脑梗死患者进展性卒中的发生率、可能的预测指标以及预后。方法将起病在24小时内486例首次发病的脑梗死患者分成四组:即完全前循环梗死组(TACI),部分前循环梗死组(PACI),腔隙性脑梗死组(LACI)和后循环梗死组(POCI)。进展性卒中的诊断根据起病到7天内肌力下降情况或神经功能缺损评分来判断。比较各组有进展与无进展的脑梗死患者的特征、危险因素、重要体征、头部CT、彩超下颈动脉粥样硬化特征以及预后情况。结果486例患者中有116例发展为进展性卒中(23.87%),其中完全前循环梗死组发生率最高为36.59%,其次为腔隙性脑梗死组26.70%及后循环梗死组20.34%,而部分前循环梗死组发生率最低为12.10%。完全前循环梗死组患者中,有进展的患者头颅CT早期异常及严重颈动脉狭窄的患者较无进展的患者多。腔隙性脑梗死组中,有进展的患者入院时血糖较无进展的高,而头颅CT早期异常率较无进展的患者低。有进展的脑梗死患者急性期病死率高,神经功能恢复差,影响到患者预后。结论不同脑梗死组患者进展性卒中的发生率不同,有进展的患者预后差。完全前循环梗死组头颅CT早期异常、颈动脉粥样硬化的严重程度及狭窄程度、腔隙性脑梗死组入院时高血糖及低头颅CT异常,均可能是进展性卒中发生的预测指标。     

牛津郡社区卒中项目分型与急性缺血性卒中患者卒中严重程度和转归的相关性

目的 探讨牛津郡社区卒中项目(Oxfordshire Community Stroke Project, OCSP)分型与急性缺血性卒中严重程度和转归的相关性.方法 前瞻性纳入急性缺血性卒中住院患者,按照OCSP分型分为完全前循环梗死(total anterior circulation infarct, TACI)、部分前循环梗死(partial anterior circulation infarct, PACI)、后循环梗死(posterior circulation infarct, POCI)和腔隙性梗死(lacunar infarction, LACI).记录患者的人口统计学和基线临床资料.应用美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale, NIHSS)评价卒中严重程度,≤8分为轻度卒中,>8分为中重度卒中.以发病后90 d改良Rankin评分(modified Rankin Scale, mRS)评价临床转归,转归良好定义为mRS评分0~2分,转归不良定义为mRS评分3~5分、死亡或发生心血管事件.采用多变量logistic回归分析确定OCSP分型与卒中严重程度和转归的独立相关性.结果 共纳入765例急性缺血性卒中患者,TACI型46例(6.0%),PACI型281例(36.7%),POCI型229例(29.9%),LACI型209例(27.3%);轻度卒中580例(75.8%),中重度卒中185例(24.2%);失访17例,513例(68.6%)转归良好,235例(31.4%)转归不良.各OCSP分型基线NIHSS评分和转归差异均有统计学意义(P均<0.05),其中TACI型基线NIHSS评分最高,转归最差,转归不良的患者比例高达89.1%;LACI型组基线NIHSS评分最低,转归相对较好,转归不良的患者比例为8.9%;PACI型基线NIHSS评分与POCI型存在显著性差异(P<0.05),但转归不良的患者比例则不然.多变量logistic回归分析显示,TACI是中重度卒中(优势比84.881,95%可信区间20.307~354.792;P<0.001)和转归不良(优势比21.472,95%可信区间8.362~55.136;P<0.001)的独立危险因素.结论 OCSP分型与急性缺血性卒中严重程度和转归独立相关.     

急性脑梗死OCSP分型与颈动脉粥样硬化的相关性

目的 探讨急性脑梗死患者OCSP分型与颈动脉粥样硬化的相关性.方法 对146例急性脑梗死患者进行OCSP分型,应用彩色多普勒超声检测脑梗死患者颈动脉病变情况,分析颈动脉粥样硬化斑块与急性脑梗死OCSP各亚型的相关性.结果 急性脑梗死患者OCSP各亚型构成比为:部分前循环梗死为43.1%,腔隙性梗死为39.0%,后循环梗死为11.6%,完全前循环梗死为6.3%;急性脑梗死患者颈动脉有斑块者占70.5%,完全前循环梗死+部分前循环梗死组患者中占斑块检出率的55.3%;不稳定性斑块患者的检出率为46.9%、斑块≥4个的患者为33.3%、斑块平均个数为3.26±1.87个,明显高于其它两型(P0.05).结论 颈动脉粥样硬化斑块及斑块稳定性、个数与完全前循环梗死和部分前循环梗死的形成密切相关,对颈动脉彩色多普勒超声检查有斑块检出者应尽早进行干预.     

缺血性脑卒中病因分型与临床分型的关系

目的探讨缺血性脑卒中急性期的病因分型与临床分型是否有关。方法回顾性调查急性缺血性脑卒中患者226例,分别在急性期行临床分型,和完善辅助检查后行病因分型,通过统计学处理了解二者是否相关。结果早期的临床分型与病因分型有关(P=0.012),其中,完全前循环梗死中有44.12%的患者具有颅内大动脉的异常,而腔隙性梗死中病因为小动脉闭塞的占48.72%,未发现部分前循环梗死与病因的明确关系。结论缺血性脑卒中急性期的临床分型能部分预示病因,指导临床诊治。     

缺血性卒中患者的牛津郡社区卒中项目分型与危险因素的关系

目的探讨缺血性卒中患者牛津郡社区卒中项目（OCSP）的分型及各亚型与卒中危险因素的关系。方法前瞻性连续登记发病到入院〈2周的缺血性卒中患者932例。根据OCSP分型标准,将其分为完全前循环梗死（TACI）、部分前循环梗死（PACI）、腔隙性梗死（LACI）及后循环梗死（POCI）4组。记录患者的性别、年龄、民族以及高血压、糖尿病、高脂血症、吸烟、饮酒史情况。分析不同危险因素对各卒中亚型发生风险的影响。结果@932例中,LACI组为463例（49．7％）、PACI组为326例（35．0％）、POCI组为78例（8．4％）、TACI组为65例（7．0％）。②年龄、高血压、糖尿病、高脂血症、脑出血、吸烟史在各亚型组间的差异无统计学意义。POCI组中,男性比例最高（75．6％）;TACI组中,回族（21．5％）、缺血性卒中（36．9％）、心房颤动（20．0％）及短暂性脑缺血发作（TIA）患者（21．5％）的比例最高（21．5％）;LACI组中,饮酒者比例最高（50．3％）。③糖尿病、高血压、高脂血症、吸烟、饮酒、缺血性卒中、TIA、脑出血、心房颤动史对POCI发生的相对危险性差异均无统计学意义;糖尿病、高血压、高脂血症、吸烟史对各型卒中发生的相对危险性差异也均无统计学意义。饮酒史和TIA史增加了LACI的风险（OR=1．488,95％CI：1．148～1．928;OR=1．686,95％C1：1．155—2．462）;缺血性卒中史增加了PACI和TACI的风险（OR=1．466,95％CI：1．058～2．032;OR=2．472,95％CI：1．453—4．205）;脑出血史和心房颤动增加了TACI（OR=2．570,95％CI：1．036—6．379）;OR：4．266,95％CI：2．174—8．368）的风险。结论OCSP各亚型中,LACI亚型的发生率最高;不同的危险因素可能增加OCSP不同亚型的发生风险。     

老年缺血性脑卒中患者按牛津郡社区脑卒中规划临床分型与预后的关系

目的探讨老年缺血性脑卒中患者按牛津郡社区脑卒中规划(OCSP)临床分型及其与预后的关系。方法采用回顾性队列研究的方法,对208例老年缺血性脑卒中患者按照OCSP临床分型并进行随访,分析各亚型与复发和死亡的关系。结果OCSP各亚型构成比分别为完全前循环脑梗死占10.6%,部分前循环脑梗死占24.0%,后循环脑梗死占4.3%,腔隙性脑梗死占61.1%。各亚型的复发率无统计学差异,完全前循环脑梗死1年病死率(63.6%)显著高于其他3型(P<0.05)。OCSP临床分型(HR=1.91,95%CI:1.09~3.34)、有并发症(HR=4.04,95%CI:1.52~10.76)和格拉斯哥昏迷评分低(HR=3.79,95%CI:1.24~11.63)是缺血性脑卒中患者死亡的主要危险因素。结论OCSP临床分型可以为缺血性脑卒中患者的预后判断提供参考依据。     

心房颤动脑梗死患者OCSP临床分型与预后的研究

目的探讨心房颤动脑梗死患者的牛津郡社区卒中项目OCSP临床分型及预后。方法采用前瞻性队列研究,将1019例脑梗死患者分为心房颤动脑梗死组(房颤组)91例和无心房颤动脑梗死组(无房颤组)928例;又按OCSP临床分型标准分为完全前循环梗死44例、部分前循环梗死552例、后循环梗死300例和腔隙性梗死123例。进行随访并比较2组预后。结果与无房颤组比较,房颤组患者完全前循环梗死比例明显增加,后循环梗死、腔隙性梗死比例明显减少(P<0.01);美国卫生研究院卒中量表评分及改良Rankin评分明显升高(P<0.05,P<0.01)。2组部分前循环梗死比例差异无统计学意义(P>0.05)。房颤组患者预后不良率为71.4%,发病1年时复发率为31.3%,病死率为30.0%;无房颤组患者预后不良率38.4%,发病1年时复发率为16.5%,病死率为10.3%,差异有统计学意义(P<0.01)。结论心房颤动脑梗死患者较无心房颤动患者预后差。     

急性脑梗死OCSP分型与大脑中动脉病变的相关性研究

目的评价数字减影血管造影术对急性大脑中动脉(MCA)区域脑梗死MCA病变诊断价值。方法选择南京大学医学院临床学院神经内科2002年5月至2005年12月收治的脑梗死患者,结合牛津郡社区卒中项目(OCSP)分型进行相关性研究,154例入组患者被分为完全前循环梗死(TACI)、部分前循环梗死(PACI)和腔隙性梗死(LACI)。结果TACI组出现MCA主干闭塞的比例高于LACI组(P<0·01),LACI组MCA正常的发生率高于TACI组(P<0·01)。结论在MCA区域脑梗死的患者中,TACI组可预测MCA主干闭塞,LACI可预测MCA正常。     

脑梗死后全身炎症反应综合征的研究

目的 探讨急性脑梗死后全身炎症反应综合征(SIRS)及相关临床因素与预后的关系.方法 采用前瞻性试验设计,对500例急性脑梗死患者进行SIRS及各相关因素调杏,并行单因素分析和Cox回归生存分析.结果 500例脑梗夕匕患者中SIRS 85例,其中完全前循环发生SIRS 31例;部分前循环34例,后循环15例;腔隙性梗死5例.脑梗死患者出现发热后,不同类型腑梗死SIRS发生率与病死率有较强的一致性(Spearman 1.0,P＜0.001).单因素分析年龄、感染、48h神经功能缺损评分,48h Glassgow评分、牛津郡社区卒中计划(OCSP)、吞咽困难、糖尿病为SIRS危险因素;SIRS为脑梗死后21d病死率的危险因素.Cox回归分析显爪脑梗死预后的独立危险凶素为48h Glassgow评分,SIRS人选方程,但P值＞0.05.结论 急怀性脑梗死后SIRS及其相关危险因素与脑梗死21d内病死率显著相关,糖尿病脑梗死患者SIRS发牛率高.脑梗死患者出现发热后,不同OCSP分型脑梗死SIRS发生率与病死率有较强的一致性.     

合并2型糖尿病的缺血性脑梗死复发危险因素研究

目的分析合并2型糖尿病的急性缺血性脑卒中患者首次发生脑梗死与复发脑梗死的临床特点。方法采用Logistic回归分析,回归模型以脑梗死为因变量,年龄、性别、高血压病、糖尿病、三酰甘油(TG)、胆固醇、低密度脂蛋白(LDL-C)、高密度脂蛋白、纤维蛋白原、血小板聚集率、尿酸、同型半胱氨酸、颈动脉斑块及吸烟为自变量,分析缺血性脑卒中的危险因素。回顾性分析合并2型糖尿病的缺血性脑卒中首次发生脑梗死100例患者的临床资料,与复发性脑梗死100例患者进行对比分析。结果年龄、糖尿病、LDL-C、颈动脉斑块及吸烟是缺血性脑梗死的独立危险因素。合并糖尿病的缺血性脑卒中首次脑梗组年龄63.26岁±9.93岁,入院时收缩压、舒张压均高于复发脑梗死组,收缩压结果有统计学意义(P<0.05);首次脑梗组胆固醇、TG、LDL-C均高于复发组(P<0.05);复发脑梗组年龄66.35岁±9.51岁,纤维蛋白原、血小板聚集率均高于首发组(P<0.05)。颈动脉斑块性质分析,两组均以硬斑为主,结果无统计学意义。首发组入院及出院时NHISS评分均低于复发组(P<0.05)。合并糖尿病的急性缺血性脑卒中首发组以部分前循环梗死(PICA)比例最多,而复发组以腔隙性脑梗死(LACI)比例最多,结果有统计学意义。结论合并2型糖尿病的缺血性卒中,首次脑梗死组收缩压高,血脂明显异常,而复发脑梗组血液黏度升高;首次脑梗组以部分前循环梗死为主,复发脑梗组以腔隙性脑梗死为主,呈多灶病变;复发脑梗组患者预后差,遗留神经功能缺损较明显,住院时间延长,卒中相关性痴呆发生率高。     

不同脑梗死分型与脑卒中后抑郁和认知功能障碍的关系

目的探讨不同脑梗死分型与脑卒中后抑郁(PSD)和认知功能障碍的关系。方法选择脑卒中急性期患者158例,脑出血35例,脑梗死123例(其中PSD患者55例,非PSD患者68例)。发病2周后采用汉密尔顿抑郁量表和简易智能状态检查量表(MMSE)进行评分,并进行TOAST和牛津郡社区脑卒中项目(OCSP)分型。结果与非PSD患者大动脉粥样硬化型和部分前循环梗死比较,PSD患者大动脉粥样硬化型和部分前循环梗死PSD发生率明显升高(P=0.002,P=0.000),小动脉闭塞型和腔隙性梗死患者PSD发生率明显降低(P=0.002,P=0.003)。与非小动脉闭塞型、非腔隙性梗死患者比较,小动脉闭塞型、腔隙性梗死患者MMSE评分明显升高(P=0.021,P=0.038)。脑出血患者发生认知功能障碍比率大于脑梗死患者(34.3%vs 14.6%,P=0.013)。结论大动脉粥样硬化型患者PSD发生率较高,小动脉闭塞型和腔隙性梗死患者PSD发生率较低、认知功能受损程度轻;部分前循环梗死患者PSD发生率较高、认知功能受损程度重。脑出血较脑梗死易发生认知功能障碍。     

Carotid atherosclerosis,coronary atherosclerosis and carotid intima-media thickness in patients with ischemic cerebral disease: Is there any link?

OBJECTIVES: The present study examined the association between carotid atherosclerosis, coronary atherosclerosis and common carotid artery intima-media thickness (CCA-IMT) in patients with incident ischemic stroke and its subtypes (75 cases and 21 controls). METHODS: Cases with ischemic brain infarctions (IBIs) were consecutively recruited and classified into subtypes by computed tomography and Bamford's classification (the size and site of the infarct) as one of the following: total anterior circulation infarcts (TACIs); partial anterior circulation infarcts (PACIs); posterior circulation infarcts (POCIs); and lacunar infarcts. Controls were recruited among individuals hospitalized for a reason other than cerebrovascular disease at the same institutions and matched for age and sex. Patients and controls underwent B-mode ultrasonographic measurements of CCA-IMT, and were evaluated by a qualified internist and neurologist for the presence of ischemic coronary disease and a history of previous stroke or transient ischemic attack. RESULTS: Of the 75 patients with an acute ischemic stroke, 10 (14%) were classified as TACIs, 34 (45%) as PACIs, 12 (16%) as POCIs and 19 (25%) as lacunar infarcts. Mean CCA-IMT was higher in patients (1.03+/-0.18 mm) than in controls (0.85+/-0.18 mm; P<0.0001). The history of cerebrovascular disease was much lower in the patients with POCI and TACI, and the prevalence of ischemic cardiac disease was in the range of 20% in patients with TACIs to more than 40% in patients with PACIs. CONCLUSIONS: An increased CCA-IMT as a marker of general atherosclerosis was associated with IBI and reflects cardiovascular risk. Carotid and coronary atherosclerosis were positively correlated with IBIs, with significant differences across the subtypes.     

颈动脉斑块在脑梗死亚型间分布差异及相关性分析

目的研究不同临床和影像学亚型脑梗死发生颈动脉斑块的差异。方法选取2008年2月至2011年2月在南京大学医学院附属鼓楼医院神经内科住院治疗的251例缺血性脑血管病患者根据头颅磁共振结果分为脑梗死和非脑梗死组并以后者作为对照,根据超声检查颈动脉内膜-中膜厚度以确定颈动脉斑块的有无。比较脑梗死组和对照组颈动脉斑块的阳性率,并进一步分析其在各临床和影像学分型中的差异。Logistic回归分析颈动脉斑块与脑梗死临床和影像学亚型间的相关性。结果脑梗死组斑块阳性率为74.2%(135/182),对照组为56.5%(39/69),差异有统计学意义(P<0.05)。脑梗死组内,按临床分型斑块发生率由高向低的次序为部分前循环梗死(PA-CI)、腔隙性脑梗死、后循环梗死、完全前循环梗死,其中PACI(83.8%)较对照组明显升高(P<0.05)。按影像学分型斑块发生率由高向低的次序是放射冠梗死、前循环皮质梗死、基底节区梗死、后循环梗死,其中放射冠梗死(85.2%)、皮质梗死(75.4%)明显高于对照组。颈动脉斑块与PACI的P值和OR(95%CI)分别为0.01,2.576(1.251～5.307)。结论临床和影像学亚型对于脑梗死患者颈动脉斑块的发生具有一定的预测作用。     

64层螺旋CT检测颈动脉斑块和狭窄与前循环缺血性脑卒中的关系

目的探讨前循环颅内、外段血管斑块和狭窄分布特点及其与前循环缺血性脑卒中的关系。方法选择80例前循环缺血性脑卒中患者为实验组,另选同期60例非缺血性脑卒中患者为对照组,入院1周内检测血脂、血尿酸及64层螺旋CT血管成像,检测双侧前循环颅内、外段斑块性质及血管狭窄程度。结果与对照组比较,实验组血管狭窄检出率明显升高(73.3%vs 91.3%,P<0.01),斑块发生率明显升高(55.0%vs 90.0%,P<0.01)。与颅外段血管中重度狭窄比较,颈动脉颅内段中重度狭窄明显增高(40.0%vs 60.0%,P<0.05)。结论颈动脉内的斑块形成及血管狭窄是前循环缺血性脑卒中发生的主要病因;颈动脉颅内段血管狭窄较颅外段常见,但颈动脉颅外段血管的不稳定斑块居多。     

Evaluation of cerebral circulation in patients with significant carotid artery stenosis

BACKGROUND: A significant proportion of ischaemic stroke episodes are caused by atherosclerotic lesions in extracranial arteries. Assessment of haemodynamical profile of cerebral arteries in both symptomatic and asymptomatic patients with carotid artery stenosis is of clinical importance. AIM: To assess haemodynamic changes in cerebral arteries in patients with significant internal carotid artery (ICA) stenosis. METHOD: Patients (n=109) were divided into the following groups: group I (GI) - 42 subjects (64.6+/-9.0 years) with asymptomatic ICA stenosis > or =70%; and group II (GII) - 67 subjects (63.4+/-7.1 years) after stroke. The control group consisted of 30 patients (60.3+/-8.9 years) without significant stenoses of extracranial arteries on USG and angiography. In all cases ultrasonographic evaluation of flow velocities and directions in cerebral arteries within the circle of Willis and collateral flow was performed. RESULTS: The severity of ICA stenosis did not differ significantly between GI and GII. Patients in GI had flow velocity in the middle cerebral artery (MCA) increased by 15.7% and by 40.8% in the anterior cerebral artery (ACA) contralateral to the ICA stenosis (p<0.001 and p<0.001), whereas in GII no significant changes in flow velocity in these arteries were observed in comparison with the control group. Patients in the groups I and II had lower flow velocities in MCA ipsilateral to the ICA stenosis, however values for GII patients were significantly lower than in GI patients (p<0.001). The presence of collateral circulation through the anterior and posterior communicating arteries (ACoA and PCoA) was similar in GI and GII; however, the flow velocities in the ipsilateral MCA and ACA were significantly higher in asymptomatic patients (GI). The frequency of active collateral circulation through both ACoA and PCoA increased along with the increase of ICA stenosis severity (p=0.003; p<0.001). CONCLUSIONS: Collateral flow in the circle of Willis in subjects with ICA stenosis occurs equally often in symptomatic and asymptomatic patients; however, it is more efficient in patients without symptoms. The rate of development of collateral circulation depends on ICA stenosis severity. The important role in maintaining collaterals within the circle of Willis is played by ACoA, although in some patients MCA may also be supplied by PCoA.     

Carotid Plaque Characteristics Predict Recurrent Ischemic Stroke and TIA: The PARISK (Plaque At RISK) Study

BackgroundPatients with symptomatic carotid stenosis are at high risk for recurrent stroke. The decision for carotid endarterectomy currently mainly relies on degree of stenosis (cutoff value >50% or 70%). Nevertheless, also, patients with mild-to-moderate stenosis still have a considerable recurrent stroke risk. Increasing evidence suggests that carotid plaque composition rather than degree of stenosis determines plaque vulnerability; however, it remains unclear whether this also provides additional information to improve clinical decision making.ObjectivesThe PARISK (Plaque At RISK) study aimed to improve the identification of patients at increased risk of recurrent ischemic stroke using multimodality carotid imaging.MethodsThe authors included 244 patients (71% men; mean age, 68 years) with a recent symptomatic mild-to-moderate carotid stenosis in a prospective multicenter cohort study. Magnetic resonance imaging (carotid and brain) and computed tomography angiography (carotid) were performed at baseline and after 2 years. The clinical endpoint was a recurrent ipsilateral ischemic stroke or transient ischemic attack (TIA). Cox proportional hazards models were used to assess whether intraplaque hemorrhage (IPH), ulceration, proportion of calcifications, and total plaque volume in ipsilateral carotid plaques were associated with the endpoint. Next, the authors investigated the predictive performance of these imaging biomarkers by adding these markers (separately and simultaneously) to the ECST (European Carotid Surgery Trial) risk score.ResultsDuring 5.1 years follow-up, 37 patients reached the clinical endpoint. IPH presence and total plaque volume were associated with recurrent ipsilateral ischemic stroke or TIA (HR: 2.12 [95% CI: 1.02-4.44] for IPH; HR: 1.07 [95% CI: 1.00-1.15] for total plaque volume per 100 µL increase). Ulcerations and proportion of calcifications were not statistically significant determinants. Addition of IPH and total plaque volume to the ECST risk score improved the model performance (C-statistics increased from 0.67 to 0.75-0.78).ConclusionsIPH and total plaque volume are independent risk factors for recurrent ipsilateral ischemic stroke or TIA in patients with mild-to-moderate carotid stenosis. These plaque characteristics improve current decision making. Validation studies to implement plaque characteristics in clinical scoring tools are needed. (PARISK: Validation of Imaging Techniques [PARISK]; NCT01208025)     

CAROTID ENDARTERECTOMY IN SYMPTOMATIC PATIENTS WITH SEVERE INTERNAL CAROTID ARTERY STENOSIS

Several clinical trials have demonstrated that carotid endarterectomy (CE) in symptomatic patients with 70–99% internal carotid artery (ICA) stenosis, when used appropriately in experienced surgical hands (postoperative complications of stroke and death must not exceed 7%) is safe and effective in preventing recurrence of ipsilateral carotid ischemia and, in particular, in preventing disabling ipsilateral stroke. Only five patients need to be treated to prevent one stroke in three years. The time of greatest risk of stroke after the development of symptoms was in the first six months, and the incremental risk decreased out to two years. Instead the risk of stroke with asymptomatic carotid stenosis is low. Forty-five percent of strokes in patients with asymptomatic 60% to 99% stenosis are attributable to lacunes or cardioembolism. Because CE cannot prevent stroke of cardioembolic origin and is less likely to prevent stroke of lacunar origin, it is doubtful that CE can be justified for most patients with asymptomatic arteries.     

Carotid endarterectomy in symptomatic patients with severe internal carotid artery stenosis

Several clinical trials have demonstrated that carotid endarterectomy (CE) in symptomatic patients with 70-99% internal carotid artery (ICA) stenosis, when used appropriately in experienced surgical hands (postoperative complications of stroke and death must not exceed 7%) is safe and effective in preventing recurrence of ipsilateral carotid ischemia and, in particular, in preventing disabling ipsilateral stroke. Only five patients need to be treated to prevent one stroke in three years. The time of greatest risk of stroke after the development of symptoms was in the first six months, and the incremental risk decreased out to two years. Instead the risk of stroke with asymptomatic carotid stenosis is low. Forty-five percent of strokes in patients with asymptomatic 60% to 99% stenosis are attributable to lacunes or cardioembolism. Because CE cannot prevent stroke of cardioembolic origin and is less likely to prevent stroke of lacunar origin, it is doubtful that CE can be justified for most patients with asymptomatic arteries.     

缺血性进展性脑卒中的相关危险因素分析

目的 分析缺血性进展性脑卒中的相关危险因素,为探讨缺血性进展性脑卒中的发病机制提供参考.方法 对356例缺血性进展性脑卒中患者的临床资料进行回顾性分析,入选患者分为进展性脑卒中组(进展组)和非进展组,按OCSP分为四型,比较各亚型的发生率,对缺血性进展性脑卒中的相关因素进行Logistic回归分析,筛选缺血性进展性脑卒中发生的危险因素.结果 完全前循环梗死亚型进展性脑卒中发病率最高,与其它亚型比较差异有显著性(P＜0.05);部分前循环梗死亚型进展性脑卒中发病率高于腔隙性梗死和后循环梗死亚型(P＜0.05).但后两者之间差异无显著性.进展组高血压史和颈动脉粥样硬化发生率显著高于非进展组(P＜0.05),进展组入院时血糖、胆固醇、甘油三酯、纤维蛋白原水平显著高于非进展组(P＜0.05);颈动脉粥样硬化和高血糖是缺血性进展性脑卒中发生的危险因素.结论 OCSP各亚型进展性脑卒中发病率各不相同,完全前循环梗死亚型进展性脑卒中发病率最高;颈动脉粥样硬化和高血糖是缺血性进展性脑卒中发生的危险因素.