缺血性中风与主动脉弓及颅内外脑动脉粥样硬化的关系

Aortic arch and intra-extra cranial cerebral arteries atherosclerosis in patients with acute ischemic stroke.

目的 探讨急性脑梗死患者主动脉弓及颅内外动脉动脉粥样硬化的发病情况及分布特点。以进一步认识缺血性中风的病因。方法 89例急性脑梗死患者均经食道超声(TEE)检查主动脉弓;同时对所有的患者进行了颈动脉超声、TCD、头部CT检查,部分患者还检查DSA及MR。结果 89例患者中52例(58.4％)发现主动脉弓动脉粥样硬化(AAA)。轻度病理性改变11例(12.4％),中度18例(20.2％),重度23例(25.8％)。45例(50.6％)检出颈动脉粥样硬化斑块。有AAA的患者,颈动脉粥样硬化斑块的发病率(37例,71.2％)明显高于无AAA组的患者(8例,21.6％),OR=3.291,P<0.001。TCD检查异常有54例(60.7％)。在AAA组中TCD的异常率也高于无AAA组(69.2％:48.7％,OR:=1.423,95％CI:O.976-2.076)。但两组差异无显著意义(P=0.05)。高龄组、男性、糖尿病史,吸烟史组AAA的阳性率明显增高(P<0.05)。结论 AAA在缺血性脑血管病的病因学中是一个应该值得重视的潜在栓塞源。具有高度危险性的颈动脉病变同样具有高度危险的主动脉病变。颈动脉斑块性病变多,严重狭窄的少,可能是构成我国颈动脉粥样硬化病变的一个特点,而且脑梗死患者动脉粥样硬化并不像以往所示以颅内段为主。高龄,男性,糖尿病史,吸烟史是AAA的重要危险因素。

Objective The aim of our study was to determine the distribution of aortic arch and intra-extra cranial cerebral arteries atherosclerosis in patients with acute ischmic stroke. Methods 89 patients with acute ischmic stroke were included in this sutdy. We used transesophageal echocardiography (TEE) to evaluate potential source of emboli in aortic arch and heart, and duplex in carotid artery. A atherosclerotic lesion of aortic arch was defined as normal(0) ; mild plaque(1); moderate plaque(2); protruding plaque or mobile plaque(3). A lesion was considered a plaque in the presence of a maximum IMT≥1.2 mm in carotis artery. We defined TCD findings as abnormal: middle cerebral artery( MCA) asymmetry index above 21 % ; and MCA no-flow. Results Of 89 patients, 52(58.43%) patients showed evidence of AAA; 11(12.36%) patients were severe, 45(50.56%) patients had carotid arterial plaques( CAP), the incident of caroid plaque were higher in patients with AAA than the group without AAA (71.15% vs21.62%, OR= 3.291,95%C1:1.740-6.225, P<0.001); The abnormal of TCD affected MCAs were found in 54(60.67%) patients; there was no difference of TCD findings between the patients with AAA and without AAA (69.23% vs 48.65% , OR = 1.423, 95%CI:0.976 - 2.076, P = 0.05) . There is higher incident of AAA in male, aged patients with diabetes and somokers. Conclusions AAA is an important potential source of cerebral embolic stroke. With carotid artery plaque correlates with AAA. The most of carotid artery lesion were plaques other than severe stenosis, it may be the character of carotid artery lesion of Chinese people. It appears that atherosclerosis do not mainly occurrence in the intracranial in stroke patients as thought before. Aged, male, diabetes, and smoking were important risk factors to the AAA.