急性缺血性脑卒中患者微栓子监测的研究进展

Research progress of microemboli monitoring on patients with acute ischemic stroke

血液中微栓子的存在被认为是缺血性脑卒中的众多独立危险因素之一,而TCD又被认为能、甚至是唯一能侦测到血液中活动微栓子信号(MES)的无创性检查方法。TCD MES监测可预测无症状颈动脉狭窄发生卒中的风险,同时提示高危、不稳定的无症状斑块,或者斑块表面有血栓;还用于颈动脉内支架成形术后的MES监测与研究,使用抗凝药或抗血小板药的评估和疗效评价等。大面积脑梗死患者的MES阳性率显著高于小面积脑梗死和TIA的患者。对于隐源性卒中或复发性TIA,TCD MES是实时发现、定位、量化脑血栓形成的金标准,是卒中早期复发的独立预测因子。但是,TCD MES的检出率及其栓子负荷与急性缺血性脑卒中患者远期预后的关系的文献尚少,需要更多的研究加以证实。

The existence of microembolus in blood flow has been considered as one of lots of risk factors of cerebral ischemic stroke. While TCD is a non-invasive and also the only approach to detect the active microembolus signals(MES) in blood flow. TCD MES monitoring has a predicting value for the risk of stroke onset, it may also suggest a high risk, unstable, and asymptomatic arterial plaque, or thrombi on the surface of a plaque. Other applications of TCD MES monitoring include the monitoring of MES after cervical artery stenting, assessment and therapeutic evaluation of anticoagulants and antiplatlet agents. Patients with a large area of brain infarct showed higher rate of MES than those with small infarct or TIA. Scholars pointed out that in patients with cryptogenic stroke or recurrent TIAs, TCD monitoring is the gold standard to detect, localize, and quantify cerebral microembolism in real time. However, not so more researches as to the relationship between the rate of MES occurrence and the burden of MES by TCD MES monitoring and the long-term prognosis of acute ischemic stroke have been reported. More research is needed to confirm this.