无症状和症状性颅内外动脉狭窄的微栓子监测

Transcranial Doppler monitor the microemboli in asymptomatic and symptomatic extracranial and intracranial arterial stenosis

目的研究无症状和症状性颅内外动脉狭窄的微栓子出现频率与缺血性卒中的发生和病程时相之间的关系。方法对临床诊断为颅内外动脉狭窄的患者,采用双通道四深度及M Mode模式进行经颅多普勒超声(TCD)微栓子监测60 min,进行微栓子信号(MES)计数。根据病变部位将患者分为颈内动脉颅外段狭窄组(ICA组)和大脑中动脉狭窄组(MCA组),每组又分为无症状组、既往缺血性卒中组(≥30 d)和急性缺血性卒中组(<30 d)。结果共监测63例患者的74条狭窄动脉。ICA组:无症状、既往缺血性卒中、急性缺血性卒中MES阳性率分别为0(0/10)、0(0/7)、33%(6/18);在MCA狭窄组分别为14%(2/14)、14%(1/7)和39%(7/18)。60 min内的MES数目在ICA急性缺血性卒中组依次为3、9、8、10、1、40个,平均11 8个;在MCA无症状组为4、1个,既往缺血性卒中组为1个,急性缺血性卒中组为4、1、4、15、16、1、29个,平均10个。MES阳性率在ICA急性缺血性卒中和无症状组之间(P=0 .013)、急性缺血性卒中和既往缺血性卒中组(P=0 .031)之间有显著性差异。在MCA狭窄急性缺血性卒中和无症状组(P=0 .115)、急性缺血性卒中和既往缺血性卒中组(P=0 .214)之间无统计学差异。结论动脉性栓塞是颅内外大动脉狭窄所致缺血性卒中的重要发病机制。距卒中时间越近,MES的发生率越高,?

ObjectiveTo determine the frequency of cerebral microembolism in patients with asymptomatic or symptomatic extracranial and intracranial arterial stenosis and to assess its relationship to the onset and course of ischemic stroke.MethodsTCD was used to monitor patients with extracranial and intracranial cerebral arterial stenosis. Double channel four-gated and power M-Mode were used to detect microembolic signals (MES). The recording time was 60 min and the number of MES was counted. Patients were divided into 2 groups as extracranial internal carotid artery (ICA) stenosis and middle cerebral artery (MCA) stenosis. Each group was divided into 3 subgroups as asymptomatic, acute ischemic stroke (<30 d) and old ischemic stroke (≥30 d).ResultsThe total number of monitored artery was 74 in 63 patients. In ICA stenosis with asymptom, old ischemic stroke and acute ischemic stroke, the frequency of MES was 0(0/10), 0(0/7), 33%(6/18) and the number of MES in acute ischemic stroke was 3, 9, 8, 10, 1, 40 (mean=11.8). In MCA stenosis with asymptom, old ischemic stroke and acute ischemic stroke, the frequency of MES was 14%(2/14), 14%(1/7), 39%(7/18) and the number of MES was 4 and 1 in asymptom, 1 in old ischemic stroke, 4, 1, 4, 15, 16, 1 and 29(mean=10) in acute ischemic stroke. In ICA stenosis, the difference between acute ischemic stroke and asymptom (P=0.013), between acute and old ischemic stroke (P=0.031) reached statistic significance.In MCA stenosis, there was no significant difference between acute ischemic stroke and asymptom (P=0.115), so as between acute and old ischemic stroke (P=0.214).ConclusionEmbolism was important in the mechanism of ischemic stroke due to extracranial and intracranial arterial stenosis. The closer to ischemic stroke onset, the higher the frequency and the number of MES. TCD monitor was helpful to study the pathogenesis of ischemic stroke due to extracranial and intracranial arterial stenosis and determine the treatment.