CAS and CEA in the Treatment of Severe Internal Carotid Artery Stenosis

Objective:To explore the clinical value of carotid artery stent implantation(CAS)and carotid endarterectomy(CEA)in the treatment of patients with severe internal carotid artery stenosis.Methods:88 patients with severe carotid artery stenosis who underwent CAS and CEA in the First People's Hospital of Changde City(hereafter referred as "our hospital")from January 2018 to December 2020 were selected as the research objects and divided into CAS group(n=43)and CEA group(n=45).To understand the clinical application value and feasibility of the two surgical schemes by comparing the general situation,cerebral blood flow,MMSE scale,MOCA scale score and serum miR-145,IGF1R levels of the two surgical schemes.Conclusions:CAS and CEA in the treatment of patients with severe internal carotid artery stenosis,have good curative effect,can effectively improve the patient's cerebral blood flow,regulate serum miR-145,IGF 1R levels,promote the recovery of cognitive function,but relatively speaking,the incidence of stroke and hypotension after CAS is higher,and the incidence of hypertension after CEA is higher.

A Comprehensive Analysis of a Case of Internal Carotid Artery Stenting

With the development of science and technology and the continuous progress of interventional equipment,internal carotid artery stenting has become increasingly popular among patients in view of its advantages,which include high efficiency,minimally invasive,and fast postoperative recovery.It has grown importance as a surgical method for the treatment of severe internal carotid artery stenosis.This paper discusses a rare case of severe internal carotid artery stenosis and its management,where various types of pre-dilatation balloons were not able to be positioned in the stenting process.Relevant solutions have also been proposed in hope to provide a more theoretical and practical basis for clinical work.

巴曲酶对CAS术后早期炎性反应干预的观察

目的通过测定循环炎性介质白介素-6(IL-6)和高敏C反应蛋白(hs-CRP)水平,观察巴曲酶能否降低颈动脉支架成形术(CAS)后炎症反应的程度。方法选择实施单侧颈动脉支架置入术的患者40例,随机分成2组,治疗组和对照组各20例。治疗组患者常规服用阿司匹林及波立维,术前24h一次性给予巴曲酶10BU治疗,术中一次性给予5BU,并在术中用5BU巴曲酶(5～10ml生理盐水稀释)浸泡支架和输送系统。对照组仅常规服用阿司匹林及波立维,不采用巴曲酶治疗。在CAS术前、术后6h和24h抽取静脉血,测定血清IL-6和CRP水平。结果治疗组和对照组术后6h和24hIL-6水平和术后24hhs-CRP水平较术前显著升高(P<0.05)。组间比较发现治疗组CAS术后6、24h的IL-6和术后24h的hs-CRP循环水平低于对照组(P<0.05)。结论巴曲酶治疗组较对照组有较低的炎症反应水平,提示巴曲酶对颈动脉支架术后的炎症反应有一定的抑制作用,对预防颈动脉支架术后炎症反应引起的再狭窄可能有潜在治疗价值。

CAS与CEA在治疗颈动脉狭窄的疗效比较研究

目的比较CAS与CEA在治疗颈动脉狭窄的疗效比较。方法选择2014年12月~2016年12月在我院就诊的拟行介入治疗及手术治疗的颈动脉狭窄患者100例为研究对象。随机分为CAS组与CEA组,分别采用CAS治疗与CEA治疗。比较两组患者1周内并发症发生率,30天内死亡率、急性脑卒中发生率以及心肌梗死发生,1年内急性心肌梗死发生率。结果术后1周,CAS组并发症发生率显著高于CEA组,差异有统计学意义(P<0.05)。术后30天CAS组急性脑卒中发生率高于CEA组,心肌梗死发生率低于CEA组,两组比较差异有统计学意义(P<0.05)。术后30天,CAS组非致残性脑卒中发生率低于CEA组,差异有统计学意义(P<0.05)。随访1年,CAS组共19例发生心肌梗死,CEA组共9例发生心肌梗死,CAS组显著高于CEA组,差异有统计学意义(P<0.05)。结论 CAS与CEA治疗颈动脉狭窄各有优缺点,在临床工作中,应根据患者具体情况,选择最佳手术方法,并积极预防近远期并发症。

颈动脉狭窄行CAS后发生CHS的危险因素研究

目的探讨老年颈动脉狭窄患者行颈动脉支架置入术(CAS)后发生过度灌注综合征(CHS)的危险因素。方法选取本院2008年6月至2013年4月收治的230例老年颈动脉狭窄患者,均行CAS治疗,根据有无CHS分为无CHS组(n=221)和CHS组(n=9),对两组患者的一般资料进行比较,独立危险因素采用分层分析法分析。结果 CHS组患者糖尿病、术后高血压发生率显著高于无CHS组,两组比较差异有统计学意义(P<0.05);分层分析法分析结果显示,糖尿病(OR=4.822,P<0.05)、术后高血压(OR=6.466,P<0.05)是CAS术后出现CHS的重要危险因素。结论颈动脉狭窄患者中CAS术后高血压和术前糖尿病史患者更容易发生CHS,CHS患者预后较差,要采取多角度干预措施防控CHS发生。

症状性颈动脉狭窄在脑保护装置下CAS治疗的疗效

目的探讨症状性颈动脉狭窄在脑保护装置下颈动脉狭窄支架成形术(CAS)治疗的临床疗效。方法将梅州市人民医院收治的症状性颈动脉狭窄患者68例随机分为观察组与对照组,每组各34例。对照组实施药物治疗,观察组在此基础上实施脑保护装置下CAS治疗,比较两组疗效。结果观察组治疗后MTT指数低于对照组,CBF、CBV指数均高于对照组,两组比较差异有统计学意义(P<0.05)。观察组治疗后的颅外颈动脉平均狭窄率为(15.12±2.67)%,NIHSS评分为(4.35±0.42)分,MRS评分为(1.47±0.26)分,均低于对照组,两组比较差异有统计学意义(P<0.05)。结论脑保护装置下CAS治疗可有效减轻症状性颈动脉狭窄患者的颅外颈动脉狭窄情况,改善靶病变血管相关区域脑灌注,提高神经功能,临床良好,值得推荐。

Significance of ultrasound evaluation of carotid atherosclerotic plaque for diagnosing ischemic cerebrovascular disease

BACKGROUND： Carotid artery is the main source for craniocerebral blood supply. Its intimal plaque formation and arterial stenosis degree both are the risk factors for ischemic cerebrovascular disease.Therefore, the close relationship of carotid atherosclerotic plaque and ischemic cerebrovascular disease, and ultrasound evaluation of carotid atherosclerotic plaque have become the hot spot in studying ischemic cerebrovascular disease.OBJECTIVE： This study was to detect the degree of carotid atherosclerosis of ischemic cerebrovascular disease patients by ultrasonography, and to analyze the situation of carotid atherosclerosis and its relationship with clinic.DESIGN： Clinical randomized concurrent control experiment.SETTING： Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA.PARTICIPANTS： Totally 60 outpatients and inpatients with ischemic cerebrovascular disease, 42 males and 18 females, admitted to Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA between January 2006 and December 2006 were involved in the patient group. They met the diagnosis criteria of ischemic cerebrovascular disease constituted by the 4th Cerebrovascular Disease Conference in 1996, and were confirmed to suffer from ischemic cerebrovascular disease by skull CT and MRI. Another 20 subjects who received healthy examination concurrently in the same hospital, 12 males and 8 females, were involved in the control group. Informed consents of detected items were obtained from involved subjects.METHODS： The plaque thickness of mid portion, distal end and crotch of common carotid artery （CCA）,internal carotid artery （ICA）, external carotid artery （ECA） and vertebral artery （VA） of involved subjects,who received health examination was separately detected with color Doppler ultrasonograph （HDI-5000）.Then, total integral of plaque was calculated. The intima-media thickness （IMT） was measured with two-dimensional ultrasonography. The inner diameter stenosis degree of subjects who had plaque was measured. Blood flow parameters were recorded, and stenosis degree and plaque area were calculated. Blood flow volume of bilateral carotid artery and VA was separately measured with ultrasound equipment software,and brain blood flow volume was calculated.MAIN OUTCOME MEASURES： Atherosclerotic degree and blood flow volume of patients of two groups.RESULTS： Sixty patients with ischemic cerebrovascular disease and twenty subjects who received health examination participated in the final analysis. ①The IMT thickness, total plaque score, and total plaque area of patient group was significantly superior to that of control group, respectively（ t=5.216 - 10.158, P 〈 0.05 ）.② There were significant differences in the stenosis degree of CCA, ICA and VA between patient group and control group （t=6.720 - 12.816, P 〈 0.05 ） . ③ The blood flow volume of CCA, ICA, VA and brain of patient group was significantly lower than that of control group, respectively （t=2.872 - 10.860, P 〈 0.05）.CONCLUSION： Ischemic cerebrovascular disease patients have different degrees of changes in atherosclerosis and arterial blood flow.

原发性高血压病CAS与HP感染的相关性研究

目的:通过观察原发性高血压病(EH)患者颈动脉内膜中层厚度(CAIMT)、幽门螺杆菌抗体(HP-IgG)、血脂、高敏C-反应蛋白(hs-CRP)及同型半胱氨酸(HCY)的结果,探讨EH患者颈动脉粥样硬化(CAS)与HP感染的相关性。方法:以150例EH患者为研究对象,检测CAIMT、血脂及血清HP-IgG、hs-CRP、HCY结果,CAIMT的测量采用彩色多普勒超声仪,HP-IgG检测采用胶体金法,据CAIMT和HP-IgG结果分组后进行统计学对比分析。结果:1150例EH患者中89例CAIMT>1.0 mm为内膜增厚,67例HP-IgG(+)为HP感染。HP感染CAIMT增厚者显著高于HP非感染者(P<0.05),CAIMT增厚HP感染者显著高于CAIMT非增厚者(P<0.05)。2EH组患者并发CAIMT增厚与HP感染具有显著相关性(r=0.787,P<0.01)。3HP感染者血清TG、TC、LDL-C、HCY和hs-CRP水平均显著高于HP非感染者(P<0.05),血清HDL-C水平显著低于HP非感染者(P<0.05)。结论:EH患者CAS与HP感染具有相关性,可能通过影响血脂代谢、炎性反应及HCY水平促进CAS发生发展,清除或预防HP感染可能是防治EH合并CAS的策略之一。

Ultrasound Assessraent of Intima-media Thickness and Diameter of Carotid Arteries in Patients Undergoing Hemodialysis or Renal Transplantation

Renal transplant （RT） recipients have a high risk of developing cardiovascular diseases. However, the effects of renal transplantation on the development of arteriosclerosis have been controversial. The carotid intima-media thickness （CIMT） and diameter （CD） are important indicators of vascular remodeling and arteriosclerosis. In this study, 31 patients with hemodialysis （HD）, 31 RT recipients and 84 age- and gender-matched control subjects were enrolled. Their CIMT and CD were measured by ultrasonic radiofrequency tracking, and the linear regression models and Z test were used to identify the progression of arteriosclerosis and the risk factors. Compared with HD group, RT group had significantly lower CIMT and CD. CIMT was found to be associated with age, body weight, resistance index and diastolic velocity, while CD was associated significantly with age, body weight, pulsatility index, end diastolic velocity and diastolic blood pressure （DBP）, respectively. The correlation curves between CIMT and age showed the slopes of curves were decreased successively in control, RT and HD groups, and the curves between CD and age showed the slopes were decreased in order of RT 〉 control 〉 HD groups. It was concluded that CIMT and CD were significantly correlated with age in RT and moderately with age in HD patients. RT could reduce the progress of arteriosclerosis in patients with end-stage renal disease.

Brachial-ankle pulse wave velocity is an independent predictor of carotid artery atherosclerosis in the elderly

Objective Brachial-ankle pulse wave velocity （baPWV） is widely used as a simple noninvasive measure of arterial softness. The aim of this study was to evaluate the usefulness of baPWV as a predictor of the carotid artery atherosclerosis in the elderly. Methods A total of 721 elderly participants （mean ~ SD age, 70.3 -4- 5.6years） were enrolled in the current study. All participant underwent both baPWV measurement and B-mode ultrasound for the intima-media thickness. Carotid atherosclerosis （CAS） was defined as the present of carotid plaque or and/or intima media thickness for at least 1.1 mm. Results A multivariate logistic regression analysis reveals that age, sex, brachial-ankle pulse wave velocity, smoking and LDL-C level showed a significant correlation with the presence of CAS. The odds ratios of CAS associated with a 500cm/s increase of brachial-ankle pulse wave velocity were 2.378 [95% confidence interval, 1.36 to 4.00, P〈0.05], 3.733 [95% confidence interval, 1.729 to 8.058, P〈0.01], 4.438 [95% confidence interval, 1.659 to 11.803, P〈0.01]. The baPWV significantly correlated with IMT by bivariate correlation analysis （r=-0.39; p=0.001）. After adjusting for factors influencing, baPWV all the same correlated with IMT （r=-0.35; p=0.001）.Conclusion These results indicate that brachial-ankle PWV is an independent predictor of CAS in the elderly.It also means that the direct measurement of arterial stiffness by this simple method may be of great help for the evaluation of carotid artherosclerosis, at least in the elderly

Cerebrovascular hemodynamics in patients with cerebral arteriosclerosis

The present study observed hemodynamic changes in 26 patients with cerebral arteriosclerosis using a cerebral circulation dynamics detector and transcranial Doppler. In patients with cerebral arteriosclerosis the blood supply and flow rate in the bilateral carotid arteries and the blood flow rate in the anterior cerebral and middle cerebral arteries were similar to normal controls, but the cerebral vascular resistance, critical pressure and pulsatility index were increased, and cerebral arterial elasticity and cerebral blood flow autoregulation were decreased. Compared with the lesioned hemisphere of patients with cerebral infarction, the total blood supply and blood flow rate of patients with cerebral arteriosclerosis were higher. Compared with normal subjects, patients with cerebral arteriosclerosis exhibited cognitive disturbances, mainly in short-term memory, attention, abstract capability, and spatial and executive dysfunction. Results showed that cerebral arteriosclerosis does not directly affect the blood supply of a cerebral hemisphere, but affects cognitive function. The increased cerebral vascular resistance and reduced autoregulation of cerebral blood vessels may be important hemodynamic mechanisms of arteriosclerosis-induced cerebral infarction.

Carotid artery stenting in the elderly: the time has come

Introduction Affecting over half a million people per year, stroke is the third leading cause of death in the United States. Approximately 30% of strokes are caused by carotid occlusive disease.……

CAS-Complications Rate and Relation to Risk Factors

Purpose: The aim of the study was to evaluate the risk factors for CAS with cerebral protection and the incidence of complication in patients with severe carotid stenosis. Materials and Methods: Overall, 95 consecutive patients with an average age of 64.67 years (28 - 83) (16 women (17%) and 79 men (83%)) were enrolled in the prospective monocentric study. Indication for CAS was symptomatic carotid stenosis ≥70% (n = 60 (63.16%)) or asymptomatic stenosis ≥80% (n = 35 (36.84%)) according to the NASCET criteria on DSA, which were not suitable for surgery. Results: From the selected risk factors, the most frequently found were arterial hypertension in 87 patients (91.6%), ischemic heart disease in 70 (73.7%), hyperlipidemia in 61 (64.2%), history of stroke in 43 (45.3%), diabetes mellitus in 35 (36.8%), smoking in 13 (13.7%), and age more than 75 years in 9 (9.5%). Significantly more frequent complications in elderly patients (more than the age of 75 years) were experienced: TIA (p = 0.049), early death (p = 0.049), restenosis (p = 0.04), and overall mortality (p = 0.04). Conclusion: Among the studied risk factors, only patients more than the age of 75 years were affected by the incidence of serious complications.

Research Progress of Traditional Chinese Medicine in the Treatment of Carotid Atherosclerosis

Carotid atherosclerosis is a partial manifestation of arteriosclerosis of organism.In recent years,its incidence rate is increasing year by year.Traditional Chinese medicine(TCM)has a broad prospect in the clinical development of CAS treatment by holism concept and the principle of treatment based on syndrome differentiation.This paper reviews the etiology,pathogenesis,TCM dialectics and TCM treatment of carotid atherosclerosis,in order to provide theoretical guidance for TCM treatment of CAS patients.

Evaluation of carotid angiography and stenting for patients with contralateral carotid occlusion

Objective To discuss the efficiency and safety of carotid angioplasty stenting (CAS) in patients with contralateral carotid artery occlusion. Methods From January 2010 to January 2010,56 carotid artery stenosis patients with contralateral carotid occlusion were performed CAS and the feature and results of these

高血压患者颈动脉粥样硬化与血清中sICAM-1水平及K469E基因多态性的相关性研究

目的:探讨细胞间黏附分子-1(ICAM-1)K469E基因多态性与高血压患者颈动脉粥样硬化关系及血清中的ICAM-1(sICAM-1)对其影响。方法:采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术以及酶联免疫吸附试验(ELISA)对201例高血压患者和106例对照者的细胞间黏附分子K469E基因多态性及血清中sICAM-1水平检测。结果:高血压组ICAM-1基因型及等位基因频率与对照组比较差异无统计学意义,但在高血压患者中KK基因型颈动脉内膜-中膜厚度(IMT)比E基因携带者高血压患者的厚。高血压患者血清中sICAM-1水平及IMT较对照组增加,并且血清中sICAM-1水平随着高血压患者IMT增厚而增加。结论:在高血压人群中,ICAM-1 K469E基因多态性与颈动脉粥样硬化有关,E等位基因可能是颈动脉硬化遗传易感性基因,而且sICAM-1与颈动脉IMT密切相关。

Ca^(2+)阻滞剂非洛地平对高脂饮食SD大鼠颈动脉球囊损伤后内膜增生的影响

目的观察Ca2+阻滞剂非洛地平对高脂饮食SD大鼠颈动脉球囊损伤后动脉内膜增生的影响。方法2F球囊导管造成大鼠颈动脉内膜剥脱后,将27只大鼠随机分为3组,标准饲料组,高脂饲料组、高脂饲料+非洛地平组(5mg.kg-1.day-1)。给药3个月测定血压后,腹主动脉取血,并行腹主动脉插管灌注固定颈总动脉,HE(苏木素/伊红)染色,用图象分析仪观察颈总动脉血管腔面积(L)、血管壁(中膜)面积(W),并计算其比值(W/L)。分光光度计分别测定血浆谷胱甘肽水平及谷胱甘肽过氧化酶、谷胱甘肽还原酶活性。结果高脂饲料组SD大鼠血浆甘油三酯(triglyceride,TG)、胆固醇(cholesterol,TC)、LDL水平较标准饲料组明显增高(P<0.05),与高脂饲料组比较,非洛地平组血浆脂质代谢产物MDA水平显著降低(P<0.05),GXH、高密度脂蛋白胆固醇(high densitylipoprotein-cholesterol,HDL-C)水平明显升高(P<0.05),皿浆谷胱甘肽还原酶及其过氧化酶活性明显增强(P<0.05);损伤颈动脉高脂饲料组明显增厚,局部并有斑块形成。非洛地平组W/L明显著小于高脂饲料组(P<0.05)。结论(1)Ca阻滞剂可降低高脂饮食SD大鼠颈动脉球囊损伤后内膜增生;(2)Ca阻滞剂可增加SD大鼠血浆谷胱甘肽,谷胱甘肽过氧化酶、谷胱甘肽还原酶活性,降低血脂代谢产物MDA水平。(3)高脂条件氧化还原产物失衡可能是血管内膜损伤后增生的重要因素。

术前服用阿托伐他汀对同期行CABG和CEA术患者预后的影响

目的探究术前应用阿托伐他汀对同期行冠状动脉旁路移植术(CABG)和颈动脉内膜剥脱术(CEA)治疗患者预后的影响。方法将同期行CABG和CEA治疗的60例冠心病(CHD)合并颈动脉狭窄患者随机分为研究组与对照组,各30例。研究组术前服用阿托伐他汀钙,对照组未服用。对比两组手术情况,以及术前1 w和术后1 w超声心动图和实验室指标及随访1年预后情况。结果与对照组相比,研究组术后颈动脉狭窄处血液流速明显低,左心室射血分数(LVEF)明显高(P <0.05);术后血清C反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、基质金属蛋白酶(MMP)-9水平明显低(P <0.05)。随访期内,两组均无死亡病例,但研究组主要不良心脑血管事件(MACCE)发生率明显低于对照组(P <0.05)。结论 CHD合并颈动脉狭窄同期介入手术患者术前应用阿托伐他汀,可改善术后颈动脉狭窄,提高心功能,减轻全身炎症反应,改善患者预后。

川芎嗪对模拟失重大鼠颈动脉平滑肌Ca^(2+)敏感性的影响

目的:探讨川芎嗪对模拟失重大鼠颈动脉平滑肌收缩蛋白Ca^(2+)敏感性的影响及机制。方法:21只雌性SD大鼠分为对照组(CON)、模拟失重组(TS)、模拟失重+川芎嗪灌饲组(LTZ)(n=7)。4周后测定大鼠颈动脉收缩性、收缩蛋白Ca^(2+)敏感性及肌球蛋白轻链激酶抑制剂ML-7对以上指标的影响。结果:TS组苯肾上腺素(PHE)收缩力比CON组高25.14%(P<0.01),LTZ组较TS组低13.46%(P<0.01),较CON组高8.30%;ML-7可使CON、TS、LTZ组PHE收缩力分别降低8.84%、16.24%(P<0.01)和3.40%;TS组KCl收缩力比CON组高40.46%(P<0.01),LTZ组较TS组低18.80%,较CON组高14.05%;ML-7可使CON、TS、LTZ组KCl收缩力分别降低21.97%(P<0.05)、21.88%(P<0.01)和10.84%;TS组pD_2[Ca^(2+)]比CON组高10.03%(P<0.01),LTZ组较TS组低7.01%(P<0.01),较CON组高2.32%;ML-7可使CON、TS、LTZ组pD_2[Ca^(2+)]分别降低2.42%、7.43%(P<0.01)和2.51%。结论:模拟失重大鼠颈动脉收缩增强可能是由动脉平滑肌收缩蛋白Ca^(2+)敏感性增强所导致的。川芎嗪可改善模拟失重大鼠颈动脉的收缩功能,其机制可能与抑制血管平滑肌肌球蛋白轻链激酶继而降低Ca^(2+)敏感性有关。

Ca^(2+)在链霉素对大鼠颈动脉窦压力感受器反射影响中的作用

在 2 3只隔离灌流颈动脉窦区的麻醉大鼠上 ,观察了链霉素 (streptomycin ,SM)对动脉压力感受器反射影响的离子机制。结果 :(1)用SM (2 0 0 μmol/L)隔离灌流大鼠颈动脉窦区时 ,压力感受器机能曲线向右上方移位 ,曲线最大斜率及反射性血压下降幅度均减小 (P <0 0 1) ,提示SM对压力感受器反射有抑制作用 ;(2 )预先灌流高Ca2 +溶液 (4mmol/L)后 ,可部分消除SM (2 0 0 μmol/L)对压力感受器反射的抑制作用 (P <0 0 1) ,使其压力感受器机能曲线向左下方移位 ,曲线的最大斜率由 0 2 7± 0 0 4增至 0 37± 0 0 2 (P <0 0 1) ,反射性血压下降幅度由4 32± 0 14kPa增至 6 18± 0 17kPa (P <0 0 1) ,而阈压和饱和压则分别从 10 2 9± 0 2 9和 2 7 2 6± 0 42kPa降至9 98± 0 33和 2 5 2 2± 0 38kPa (P <0 0 5 ) ;(3)用Ca2 +通道激动剂BayK 86 44 (5 0 0nmol/L)预处理 ,可完全消除SM(2 0 0 μmol/L)对压力感受器反射的抑制效应 ;(4 )预先给予Ca2 +激活性K+通道阻断剂 (charybdotoxin ,ChTX ,10 0nmol/L) ,对压力感受器反射无明显影响 ,加入SM后仍呈现抑制作用。以上结果表明 ,SM可能是通过抑制颈动脉窦压力感受器中机械敏感性通道的Ca2 +内流而发挥作用。