家兔颈总动脉剥脱术后新生内膜增殖和血管重塑动态变化模型的研究

目的探索再狭窄(RS)的发病机制进行干预研究,复制家兔颈总动脉内膜损伤后不同时间点内膜增殖和血管重塑动态变化模型。方法选用家兔70只行颈总动脉内膜球囊损伤,分别检测未损伤侧(N)和损伤后1d、3d、5d、7d、14d、28d、35 d管腔面积(LA)、内膜和中膜厚度及面积、以及外弹力膜横截面积(EELA)。结果损伤后1d可见动脉内皮剥脱;3d管腔内表面可见增殖的血管平滑肌细胞(VSMC);5~7 d新生内膜(NI)形成并增厚,14 d以后NI厚度及面积逐渐增加,至35 d达最大,同时细胞外基质(ECM)也逐渐增加。损伤后3~14 d中膜厚度及面积逐渐增加,其中14 d中膜面积明显大于N,28~35 d趋于降低。LA于损伤后5~7 d开始减少;14 d以后明显小于N。损伤后1~7 d EELA逐渐增大,至14 d达最大,28 d后开始回缩。结论家兔颈总动脉球囊损伤能较好的模拟RS形成过程,内膜增殖与血管重塑均是RS形成的主要病理机制。     

Outcomes of Carotid Revascularization in Patients with Contralateral Carotid Artery Occlusion

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Importancia de la arteriografía cerebral y la monitorización neurofisiológica intraoperatoria en la endarterectomía carotídea

It is an increasingly common practice to indicate a carotid endarterectomy procedure based on the information provided by non-invasive tests like Duplex ultrasound, MR angiography or CT angiography, thereby obviating the performance of a conventional cerebral angiography. We present a case of symptomatic left carotid artery 80% stenosis in which cerebral angiography showed absence of the right A1 segment and bilateral anterior cerebral artery territories that filled only from a left injection. Just 90 seconds after carotid artery clamping at the neck, brain oximetry and somatosensory evoked potentials significantly dropped, that recovered after immediate clamp removal. Endarterectomy was dismissed and a carotid stent was successfully placed. This case highlights the importance of knowing the dynamics of cerebral blood circulation distal to the stenosis. If endarterectomy had been attempted, unawareness of the information provided by the cerebral angiography would have likely result in severe bi-hemispheric ischemia.     

兔动脉粥样硬化血管成形术后再狭窄模型的建立与改良*

 目的：探讨建立兔动脉粥样硬化血管成形术后再狭窄模型的有效方法。方法：30只雄性新西兰大白兔,随机分成3组,即空白对照组、下肢动脉切开组及下肢动脉穿刺组,每组10只。空白对照组仅行高脂饲料喂养,另外2组高脂饲料喂养1周后行下肢动脉穿刺或切开行髂动脉内膜剥脱术,继续高脂饲料喂养4周,下肢动脉穿刺组再次穿刺股动脉行髂动脉球囊成形术,下肢动脉切开组经颈动脉切开行髂动脉球囊成形术。3组均普通饲料喂养4周,计算每天进食饲料量,采血化验血脂,取病变段血管行苏木精-伊红染色及图像工作站对血管造影结果行血管狭窄分析。结果：下肢动脉切开组进食饲料量减少,血清总胆固醇和低密度脂蛋白胆固醇显著低于对照组。3组动物均出现下肢动脉粥样硬化,其中下肢动脉穿刺组及下肢动脉切开组内膜显著增厚,管腔狭窄。动脉穿刺组与动脉切开组血管面积狭窄率及直径狭窄率与对照组相比差异显著(P<0.01)。结论：下肢动脉穿刺与球囊损伤、球囊血管成形术结合可成功建立兔动脉粥样硬化血管成形术后再狭窄模型,方法简单,可重复性强,较下肢动脉切开术更适合血管成形术后再狭窄模型的建立。     

颈动脉狭窄与认知功能

颈动脉狭窄是脑血管病的重要危险因素之一.许多研究显示,颈动脉狭窄可能会导致认知损害,但具体机制尚不明确.颈动脉内膜切除术和支架置入术能解除颈动脉狭窄,提高脑灌注量,进而可能改善患者认知功能,但干预后的并发症和长期效果仍有待进一步研究.     

颈动脉狭窄与认知损害

颈动脉狭窄与认知功能的关系日益受到重视.多数研究显示,颈动脉狭窄对认知损害有直接影响.颈动脉内膜切除术或支架置入术,可不同程度改善颈动脉狭窄患者的认知功能.颈动脉疾病患者认知损害的机制可能与低灌注、白质病变、多发性腔隙性梗死以及脑自发栓子形成有关.     

Carotid endarterectomy after systemic thrombolysis in a stroke population

ObjectiveVascular specialists are increasingly being requested to perform carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) for stroke patients, raising concerns about hemorrhagic complications. Few case series and registry reports have assessed the question, and even fewer studies have included a control group. The aim of this study was to evaluate the overall outcome of patients undergoing CEA after IVT and to compare them with contemporary patients with CEA after simple stroke (non-IVT group). It also aimed to evaluate the differences in outcomes of stroke patients requiring CEA between nonvascular and vascular centers.MethodsThe data of 169 consecutive patients who have undergone CEA after stroke in a single center was analyzed from January 2011 to December 2016, 27 of them (16%) having undergone previous IVT. A comparative analysis between the non-IVT and the IVT groups was performed. The time between stroke diagnosis and referral to a vascular specialist was also studied.ResultsAge, sex, and cardiovascular comorbidities were similar in both groups. Median time between stroke and CEA was 13 days (Q1-Q3, 8-23 days), with 16 of the 27 patients (59%) in the IVT group undergoing CEA less than 14 days after the initial event. There were three intracranial hemorrhages (2.1%) in the non-IVT group versus one (3.7%) in the IVT group (P = NS). The overall 30-day combined stroke and death rate was 7.1% (6.3% in the non-IVT group vs 11.1% in the IVT group; P = .70). The incidence of postoperative cervical hematoma requiring reoperation was similar in both groups (2.1% vs 3.7%; P = NS). The median time between diagnosis of stroke and referral to a vascular specialist was higher for patients in nonvascular centers compared with vascular centers (3.5 days vs 1.0 day; P < .001), which translated to fewer patients referred from nonvascular centers undergoing surgery in the 14-day window period (38% vs 67%; P < .001).ConclusionsIn this retrospective analysis, CEA after IVT showed similar outcomes when compared with the overall CEA after stroke population. Stroke patients diagnosed in nonvascular centers were referred later than those in vascular centers and, although postoperative outcomes were similar, that was correlated with fewer patients undergoing surgery in a timely fashion.     

腔内激光结合高位结扎剥脱术在下肢静脉曲张治疗中的应用

目的探讨腔内激光结合高位结扎剥脱术在下肢静脉曲张治疗中的应用。方法122例下肢静脉曲张患者随机分为两组,观察组61例（76条肢体）,对照组61例（78条肢体）,观察组患者采用腔内激光结合高位结扎剥脱术治疗,对照组采用传统高位结扎剥脱术治疗,观察两组的疗效及并发症。结果手术后观察组总显效率为98．9％,对照组为89．7％,两组比较差异有统计学意义（P〈0．05）,随访3～6个月,观察组并发症发生率为9．2％;对照组并发症发生率为26．9％。观察组并发症发生率明显低于对照组,两组比较差异有统计学意义（P〈0．01）。结论腔内激光结合高位结扎剥脱术治疗下肢静脉曲张疗效显著,并发症少。