脑血管病颈动脉粥样硬化14例病理研究

Pathologic analysis of the relationship between cerebral stroke and atheromatous lesions of extracranial carotid artery

目的探讨颈动脉粥样硬化与脑血管病的关系。方法对１４例脑血管病死亡病例（脑出血及脑梗死各７例）的颈动脉进行病理观察及形态定量分析。结果脑血管病患者颈动脉粥样硬化导致管腔狭窄的程度，轻度占６３％，中、重度狭窄约占３７％。脑梗死患者颈动脉粥样硬化导致管腔狭窄的程度比脑出血患者严重；７例脑梗死患者中２例的病因为颈内动脉栓塞，脑梗死患者颈动脉粥样硬化斑块具备不稳定的组织学特性，常见质地松散、密度不均易脱落的斑块。脑出血组出血灶同侧的颈内动脉较对侧显著狭窄。结论颈内动脉栓塞是大面积脑梗死的常见病因之一；不稳定的颈动脉粥样硬化导致的斑块脱落可能也是脑梗死的病因之一。

Objective To investigate the relationship between cerebral stroke and atherosclerosis of the extracranial carotid arteries. Methods 14 autopsy cases were studied, including 7 cases of cerebral hemorrhage (CH) and 7 cases of cerebral infarction (CI). The internal carotid arteries (ICA), external carotid arteries (ECA), and common carotid arteries (CCA) from 84 instances were examined with morphometric study. The degree of narrowing of the vessels indicating the severity of arteriosclerosis were determined. Quantitative analysis was carried out with the computer assisted image analysis system. Results The slight stenoses of the carotid arteries induced by atheromatosis were found to be in 53/84 (63%), while the moderate or severe stenoses occurred in 31/84 (37%). Atherosclerotic narrowing of the extracranial carotid arteries in the CI patients was slightly more severe than that in the CH paitents. The 2 ICA occlusions out of 7 cases of CI resulted from embolism. There were the unstable morphologic properties of atherosclerotic plaques in the CI group. The atherosclerotic narrowings of the ipsilateral ICA on the side of CH was significantly more sever those that of the contrateral ICA ( P <0.05). Conclusions Embolic ICA occlusion has been frequently found to be one of the causes of CI in large areas. The mural thrombi coming off from the unstable, atherosclerotic plaques may serve as the sources of small emboli and may also be one of the causes of cerebral infarction.