老年缺血性卒中患者低分子肝素试验分型及颈动脉易损斑块的研究

The study of TOAST classification in ischemic stroke and the research on vulnerable carotid artery plaque in elderly cadre

目的了解老年保健对象缺血性卒中的TOAST分型情况,探讨颈动脉斑块易损斑块的发生及其与狭窄程度的关系。方法 205名确诊缺血性卒中的老年保健对象综合临床资料进行TOAST分型,MSC-TA对颈动脉易损斑块及颈动脉狭窄进行测定。结果老年保健对象缺血性卒中的TOAST分型小血管病变最多(43.9%),不明原因(34.1%)及大动脉闭塞(19.5%)次之。96名前循环缺血性卒中患者检出有易损斑块,检出率为63.9%,不同TOAST分型间易损斑块的检出无差异(P>0.05),颈动脉不同狭窄程度的易损斑块检出率无明显差异(P>0.05)。结论老年保健对象缺血性卒中的TOAST分型有自身特点,CTA作为无创检查能对颈动脉斑块的形态学进行准确评价,易损斑块亦是老年患者卒中发生重要机制,重视斑块的性质尤为重要。

Objective To study the TOAST Classification in ischemic stroke and investigate the correlation between vulnerable carotid artery plaque and carotid artery stenosis. Methods Totally 205 elderly cadres with acute ischemic stroke were classified based on TOAST criteria. CT angiography（CTA） data were evaluated for carotid artery plaque and carotid artery stenosis in the carotid artery segment. Results Stroke subtypes in elderly cadre included small arteryocclusive disease （43.9%）, undetermined （ 34.1% ） and large artery atherosclerosis cause （ 19.5 % ）. 96 patients Vulnerable plaque occurred in 96 patients of anterior circulation ischemic. There was no difference of the occurrence of vulnerable plaque between three TOAST subtypes （P 〉 0.05 ）. There was no relationship between presence of Vulnerable Carotid artery Plaque and degree of carotid artery stenosis（P 〉 0.05）. Conclusion TOAST classification in elderly cadre differs from others in some degree. CT angiography can characterize plaque morphology and can be a useful tool in noninvasive evaluation of vulnerable plaque. The underlying vulnerable plaque composition in the elderly might be an important contributing factor to the risk of stroke.