缺血性脑血管病全脑血管造影术99例临床分析

目的：探讨缺血性脑血管病（ ICVD）患者血管病变在全脑血管造影术（ DSA）的分布及伴随疾病情况，并观察并发症，以及DSA在ICVD中的价值。方法回顾性分析99例ICVD患者的DSA资料，按缺血类型分为脑梗死（CI）组和短暂性脑缺血发作（TIA）组。所有患者经头颅3D-TOF和颈部血管彩超筛选，经DSA检查最后诊断。同时观察围手术期并发症以及伴随疾病情况。结果99例ICVD患者中，88例经DSA检查确诊存在血管病变。99例患者共存在252处病变，占前三位的为颈内动脉（ ICA）、椎动脉（ VA）以及大脑中动脉（ MCA）。同时共存在121处分叉部病变，占前三位的为ICA、VA以及颈外动脉（ ECA）。 TIA中伴随前三位疾病为高血压（HTN）、2型糖尿病（2DM）以及高脂血症和肾功能不全；CI中为HTN、2DM以及高脂血症。并发症共发生10例，最多的为血管迷走神经反射5例；严重的为TIA和CI各1例（出院时未造成任何神经功能缺损）。结论颈动脉系统血管病变在ICVD发生中起重要作用，尤其在血管分叉部易出现病变。在ICVD发病高危因素以HTN居多，其次为2-DM、高脂血症。 DSA手术严重并发症极少，能提供更全面血管信息，为进一步制定ICVD防治方案提供依据，此检查安全、可靠。

Clinical analysis of the cerebral DSA in 99 patients with ischemic cerebrovascular disease

Objective To explore the distribution of vascular lesions in the cerebral digital subtraction angi-ography（ DSA） and associated diseases in patients with ischemic cerebrovascular disease（ ICVD） ,and complications, as well as the value of DSA in ICVD.Methods The DSA data of 99 ICVD cases were analyzed retrospectively, patients treated by ischemia type were divided into the cerebral infarction（CI） and transient ischemic attack（TIA） group.All patients were examined by 3D-TOF and neck vascular ultrasound screening,the final diagnosis by DSA. While observing the perioperative complications and associated diseases.Results 99 patients with ICVD,88 cases of the presence of vascular lesions diagnosed by DSA.In 99 cases,there were 252 lesions,accounting for the top three for the internal carotid artery（ICA）,vertebral artery（VA） and the middle cerebral artery（MCA）.While there were 121 bifurcation lesions,accounting for the top three for ICA,VA,and the external carotid artery（ECA）.TIA in patients with concomitant diseases accounted for the top three for hypertension（HTN）,type 2 diabetes mellitus（T2DM） and hyperlipidemia and renal insufficiency;Patients with CI associated diseases accounted for the top three for HTN, T2DM and hyperlipidemia.There were 10 cases of patients with DSA complications,most of the vasovagal reflex in five cases;serious for TIA and CI in 1 case （ not cause any neurological deficits at discharge ） .Conclusion Carotid vascular disease plays an important role in the occurrence of ICVD, especially in the blood vessels of bifurcation lesion.Within ICVD risk factors in HTN in the majority, followed by T2DM, hyperlipidemia.DSA surgery rarely serious complications,blood vessels can provide more comprehensive information,and provide the basis for further development of ICVD prevention and treatment programs,this checking method is safe and reliable.