The application value of TCD combined with CDUS in the large artery atherosclerosis

Objective:To explore the value of TCD and CDUS on diagnosis of large artery atherosclerosis.Methods:In our study,90 patients who had been admitted to our hospital and diagnosed as LAA according to CISS typing were selected as the research object.A retrospective analysis was conducted,using CTA as golden standard for diagnoses of stenoses.Explore the risk factors of LAA,the reliability of TCD and CDUS in diagnosis of the stenosis and distribution of stenosis in each vessel.Results:Hypertension and type 2 diabetes are risk factors of LAA vascular stenosis.Middle cerebral artery stenosis detection by TCD carries the highest reliability(sensitivity 90.91%,specificity 97.89%,positive predictive value 96.15%,the negative predictive value was 94.9%,the positive likelihood ratio was 43.18,negative likelihood ratio 0.09,Kappa=0.9).The consistency of TCD is as good as CTA in head and neck part.The negative coincidence rate was higher in the anterior circulation vessels(97.98%),followed by the coincidence rate of severe stenosis(95.23%).However,the detection rate of posterior circulation vessels positive,moderate and severe stenosis,mild stenosis gradually decreased by TCD.CDUS carries general reliability in detecting intracranial extracranial stenosis,the highest reliability in internal carotid artery(kappa 0.82),and the worst consistency in vertebral artery(kappa 0.38).The negative coincidence rate of CDUS in extracranial cerebrovascular stenosis was highest(97.22),followed by the overall compliance rate(91.55%).242 branches of vascular stenosis were discovered in our study,among which intracranial artery stenosis 61.15%(148/242)is higher than that in extracranial artery 38.85%(90/242),ratio of moderate to severe stenosis is as high as 82.23%(199/242).Intracranial artery stenosis in ICA is extremely common(51.11%,46/90),and MCA is the common area of intracranial artery stenosis(37.16%,55/148).Conclusions:(1)Hypertension,type 2 diabetes are risk factors for LAA stenosis.(2)TCD detection of intracranial vascular stenosis carries the best consistency,and reliability of MCA is the highest.In our search,MCA possesses the highest rate of stenosis,and negative coincidence rate by TCD examination was the highest,which could be used for screening method for stenosis.The reliability of TCD in diagnosis of moderate and severe stenosis was relatively better than mild stenosis.(3)CDUS detection of anterior circulation lesions is better than that of posterior circulation lesions.Evaluate effect on moderate and severe stenosis was better than that of mild one.The ratio of ICA stenosis was the highest,but the effect on VA was poor.(4)The incidence of intracranial vascular stenosis is more common than that of the intracranial vascular stenosis.

Comparative Analysis of General Characteristics of Ischemic Stroke of BAD and non-BAD CISS Subtypes

Summary： Based on the recently proposed Chinese ischemic stroke subclassification （CISS） system, intracranial branch atheromatous disease （BAD） is divided into large artery atherosclerosis （LAA） and penetrating artery disease （PAD）. In the current retrospective analysis, we compared the general charac- teristics of BAD-LAA with BAD-PAD, BAD-LAA with non-BAD-LAA and BAD-PAD with non-BAD-PAD. The study included a total of 80 cases, including 45 cases of BAD and 35 cases of non-BAD. Subjects were classified using CISS system： BAD-LAA, BAD-PAD, non-BAD-LAA and non-BAD-PAD. In addition to analysis of general characteristics, the correlation between the factors and the two subtypes of BAD was evaluated. The number of cases included in the analysis was： 32 cases of BAD-LAA, 13 cases of BAD-PAD, 21 cases of non-BAD-LAA, and 14 cases of non-BAD-PAD. Dia- betes mellitus affected more non-BAD-LAA patients than BAD-LAA patients （P=0.035）. In comparison with non-BAD-PAD, patients with BAD-PAD were younger （P=-0.040）, had higher initial NIHSS score （P〈0.001） and morbidity of ischemic heart disease （P=0.033）. Within patients with BAD, the PAD sub- type was associated with smoking （OR=0.043; P=0.011）, higher low-density lipoprotein （OR=5.339; P=0.029）, ischemic heart disease （OR=9.383; P=0.047） and diabetes mellitus （OR=12.59;P=-0.020）. It was concluded that large artery atherosclerosis was the primary mechanism of BAD. The general char- acteristics showed no significant differences between the CISS subtypes of LAA and PAD within BAD, as well as between the BAD and non-BAD within LAA subtype. Several differences between PAD sub- types of BAD and non-BAD were revealed.

Overview-Research Progress of Leukoaraiosis

In 1987, Hachinski et al. [1] proposed Leukoaraiosis (LA) as an imaging academic term. Since then, LA and other cerebrovascular diseases have become the research focus of scholars at home and abroad. However, the molecular, cellular and pathogenesis of cerebrovascular disease are still unclear. Cerebral small vessel disease is caused by the lesions of perforating arteries, capillaries and veins of the brain. Modern imaging technology makes it possible to classify these diseases that can not be directly distinguished in clinical practice. The imaging features of cerebral infarction include cerebral microvascular atrophy. At present, a large number of studies have been carried out around LA, such as the pathogenesis, risk factors, imaging manifestations and classification, pathophysiological changes, hemodynamics, gene polymorphism and so on. In addition, although LA belongs to the category of cerebral small vessel disease, more scholars believe that there are countless links between large artery atherosclerosis and LA, and to some extent, have the same pathogenesis. This paper reviews the following aspects.