血流动力学在脑血管病中的应用

动脉粥样硬化是缺血性脑血管病的重要发病原因。从传统的角度，责任动脉狭窄程度一直是作为预测卒中患者复发的主要因素。CICAS研究结果发现狭窄程度在50%以下的卒中患者年复发率在0.58%～5.88%之间，表明狭窄程度并不一定能决定患者的危险动脉。因此，关注动脉狭窄程度的同时，更需关注责任动脉血流因素。从心血管领域引入血流储备分数（flow fraction reserve， FFR）的概念，将传统的冠状动脉狭窄的概念去除，也可引申用于脑血管病的研究。基于冠心病和脑卒中的相似性，冠状动脉循环可能为脑血管的FFR测量提供了最佳的参考选择。造影检查的狭窄程度不能区分出狭窄程度是否已伴有血流动力学的改变，因此降低了功能评估的价值，不能准确的判断出高风险的斑块。关注血流动力学的状态，可能对缺血性卒中患者的治疗起到个性化的治疗策略作用。

Hemodynamics in cerebrovascular disease

Atherosclerosis is the major cause of ischemic cerebrovascular disease.Traditionally, the degree of responsibility artery stenosis has always been a major factor for predicting recurrence in stroke patients. The CICAS study revealed that the annual recurrence rate of stroke patients with a narrowed degree of less than 50% was between 0.58% and 5.88%, indicating that the degree of stenosis did not necessarily determine the dangerous arteries of the patients. Therefore, we should pay more attention to the blood flow of the responsible artery, rather than the degree of arterial stenosis. The concept of flow fraction reserve (FFR) is introduced from the cardiovascular field, which removes the traditional concept of coronary stenosis, and can also be applied to the study of cerebrovascular disease. Based on the similarity between coronary heart disease and stroke, coronary circulation may provide the best reference for FFR measurement of cerebral vessels. The degree of stenosis of contrast examination can not tell whether the degree of stenosis is accompanied by changes in hemodynamics, thus reducing the value of functional assessment and inaccurately judging the high risk of plaque. Paying attention to the state of hemodynamics may play a patient tailored role in the treatment of ischemic stroke patients.