Early diagnostic value of carotid artery ultrasound parameters combined with epicardial adipose layer thickness in coronary heart disease

BACKGROUND Coronary heart disease is associated with coronary atherosclerosis indicated by carotid intima-media thickness(CIMT)thickening and altered vascular elasticity.The epicardial adipose layer can secrete proinflammatory factors that promote the formation of coronary atherosclerosis.Thus,the epicardial fat layer thickness(EAT)may also predict coronary heart disease.AIM To determine the role of common carotid artery ultrasound parameters and EAT in the early diagnosis of coronary artery disease.METHODS Based on coronary angiography,patients with newly suspected coronary heart disease were divided into case(n=107)and control(n=41)groups.The carotid ultrasound parameters,including vascular stiffness(β),elastic coefficient(EP),pulse wave conduction velocity(PWV-β),CIMT,and EAT were compared between the case and control groups and among patients with different lesion numbers in the case group.Pearson correlation was used to evaluate the early diagnostic value of EAT,common carotid artery elasticity,and CIMT for coronary heart disease.RESULTS EP,β,PWV-β,CIMT,and EAT were significantly higher in the case group compared with the levels in the control group(all P<0.001).In the case group,lesions were detected in one vessel in 34 patients,two vessels in 38 patients,and three vessels in 35 patients.Within the case group,β,EP,PWV-β,CIMT,and EAT levels significantly increased with an increased number of lesions(all P<0.001).EAT positively correlated withβ,EP,PWV-β,and CIMT(all P<0.01).The area under the curve for diagnosing coronary heart disease using EAT combined with CIMT and carotid elasticity was 0.893,and the sensitivity and specificity were 0.890 and 0.837.CONCLUSION EAT correlated well with changes in carotid artery elasticity and CIMT in patients with coronary heart disease.The combination of EAT,carotid artery elasticity,and CIMT facilitates the early diagnosis of coronary heart disease.

Ultrafast pulse wave velocity technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis patients with euthyroidism

Objective To explore the value of ultrafast pulse wave velocity(UFPWV)technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis(HT)patients with euthyroidism.Methods Conventional ultrasound and UFPWV for carotid artery were prospectively performed in 91 HT patients with euthyroidism(HT group)and 81 healthy subjects(control group).Clinical data and ultrasonic parameters were compared between groups.Spearman correlation analysis was performed to observe the correlations of carotid pulse wave velocity in end of systole(PWV-ES)with clinical indexes and other ultrasonic parameters in HT group.Multiple stepwise linear regression analysis was used to screen the independent impact factors of increased carotid PWV-ES in HT group.Results Significant differences of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb),total cholesterol(TC),low density lipoprotein and neutrophil-lymphocyte ratio(NLR)were found between groups(all P<0.05).The carotid PWV-ES in HT group was significantly higher than that in control group(P<0.05),while no significant difference of carotid artery intima-media thickness(CIMT)nor carotid pulse wave velocity in beginning of systole(PWV-BS)was found between groups(both P>0.05).Carotid PWV-ES in HT group was positively correlated with patients'age,body mass index,TPOAb,TC,triglyceride,NLR and CIMT(r=0.217—0.707,all P<0.05).Patients'age,TPOAb and NLR were all independent impact factors of increased carotid PWV-ES in HT patients with euthyroidism(all P<0.05).Conclusion UFPWV technique could be used to evaluate changes of carotid artery elasticity in HT patients with euthyroidism,among which PWV-ES was relatively sensitive.

Idiopathic steno-occlusive disease with bilateral internal carotid artery occlusion:A Case Report

BACKGROUND Moyamoya disease(MMD)is a rare cause of acute stroke and transient ischemic attacks in children.We described clinical,diagnostic features and follow-ups of a young child with acute stroke.CASE SUMMARY We report a 4-year-old girl with left hemiparesis after an acute ischemic stroke.Her history was also significant for repeated left or right focal motor seizures,generalized tonic-clonic convulsions and transient ischemic attacks.Her magnetic resonance imaging and computed tomography(CT)of the brain and magnetic resonance angiography,CT angiography and venography on the cerebral vessels revealed evidence of bilateral fronto-parietal ischemic infarctions,occlusion of the right and left internal carotid arteries started at its bifurcation and non-visualization of right and left anterior and middle cerebral arteries.There was evidence of progression in angiography manifested as development of collaterals from the basal perforating vessels,increase in the extent of large intracranial arterial stenosis/occlusion and extensive collateral circulation with predominance from the posterior circulation.Physical and neurological evaluation and comprehensive laboratory investigations excluded an obvious comorbid disease or risk factor for the child’s condition.The diagnosis of MMD was highly suggested as a cause of the child’s steno-occlusive condition.She was treated symptomatically with levetiracetam,an antiepileptic medication.Aspirin was prescribed for secondary prevention.Her clinical manifestations were improved during the three years of follow-up.Revascularization surgery was postponed.CONCLUSION Up to our knowledge,this is the first report for MMD in a child in our country.The clinical improvement and the stabilization of the child’s condition over the 3 years of follow-up could be attributed to the rapid and extensive recruitment of collaterals and absence of risk factors or comorbidities.Revascularization surgery is highly recommended.

Incidence &Risk Factors Associated with Carotid Disease in Patients Undergoing Coronary Artery Bypass Grafting Surgery

Objective: The purpose of this study was to evaluate the true incidence and the risk factors associated with carotid disease in the sitting of high risk patients undergoing coronary artery bypass graft (CABG) using carotid duplex scan and to find out if routine preoperative carotid duplex scan is needed among all these patients. Methods: This retrospective study included 402 consecutive patients who underwent bilateral carotid duplex scan admitted for CABG during the period from January 2006 to December 2008. We excluded patients in cardiogenic shock who were taken to operating room emergently. Results: The prevalence of associated risk factors showed diabetes mellitus recorded the highest (93.3%) whereas peripheral vascular disease the lowest (1.7%), hypertension (89.3%), dyslipidemia (72.6%), smoker (21.1%), left main disease (4.7%), and previous stroke (3%). Patients undergoing CABG has high incidence of carotid disease (68.7%) and severe stenosis is more in patients aged 60 and above (13.5%) versus (2.3%) in age 60, previous stroke and left main disease). Conclusion: This study showed that carotid screening is recommended for all patients who are undergoing CABG due to high incidence of carotid disease.

Synchronous carotid endarterectomy and coronary artery bypass graft: Four case reports

BACKGROUND One of the major perioperative complications for coronary artery bypass graft(CABG)is stroke.The risk of perioperative stroke after CABG is approximately 2%.Carotid stenosis(CS)is considered an independent predictor of perioperative stroke risk in CABG patients.The optimal management of such patients has been a source of controversy.One of the possible surgical options is synchronous carotid endarterectomy(CEA)and CABG.Here,we have presented 4 cases of successful synchronous CEA and CABG.Our center’s experience with 4 cases of significant carotid artery stenosis,which were successfully managed with combined CEA and CABG,are detailed.The first case was a female who presented for CABG after a ST-elevation myocardial infarction.She had right internal carotid artery(ICA)occlusion and 90%left ICA stenosis.The second case was a male who was electively admitted for CABG.It was discovered that he had left ICA occlusion and 90%right ICA stenosis.The third case was a male with a history of stroke,two months prior to admission.He presented with non-ST-elevation myocardial infarction.Preoperatively,it was discovered that he had>90%right ICA stenosis.The final case was a male who was electively admitted for CABG.It was discovered that he had bilateral>90%ICA stenosis.We have also reviewed the current evidence and guidelines for managing CS in patients undergoing CABG.CONCLUSION Our case series demonstrated that synchronous CEA and CABG was safe.A multicenter study with additional patients is needed.It is necessary for clinicians to screen for CS in high-risk patients with features.

Relationship between peripheral arterial disease, carotid intima-media thickness and C-reactive protein in elderly diabetic patients

Purpose: To study the association between carotid intima media thickness (CIMT) and high sensitivity CRP (hs-CRP) level as markers for PAD in elderly patients with DM. Subjects: A case-control study on 90 participants aged 60 years and older divided into 60 cases (30 patients with DM alone and 30 patients with DM and comorbidities) and 30 healthy controls. All were assessed by measuring CIMT, ankle brachial index (AB), and markers for cardiovascular disease such as high-sensitivity CRP (hs-CRP), total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), and low density lipoprotein (LDL). Results: hs-CRP levels showed statistically significant difference being highest among patients with DM and comorbidities and lowest among controls (P < 0.001). Also, symptoms of PAD were significantly higher among cases than controls. ABI was able to detect PAD in many asymptomatic patients. Color changes were present in only 43.30% (n = 26) of positive PAD cases while delayed wound healing, claudication pain, rest pain, cold extremities, and trophic changes were present in 23.30% (n = 14), 16.71% (n = 10), 16.71% (n = 10), 45.00% (n = 27), and 21.7% (n = 13). Using logistic regression analysis revealed that DM, CIMT, and hs-CRP were independent predictors for PAD (OR = 4.194, 7.236, 1.003;P value = 0.044, 0.25, 0.031) after adjustment of other coronary risk factors such as sex, smoking, hypertension, TC, and TG. Conclusion: Diabetic elderly have higher prevalence of asymptomatic PAD thannon-diabetics using solely ABI. DM, CIMT, and hs-CRP are independent predictors for the occurrence of PAD. Hs-CRP levels are highest among diabetics with comorbidities.

Correlation of carotid plaque vulnerability with lipid metabolism, inflammatory response and protease activity in patients with coronary artery disease

Objective: To study the correlation of carotid plaque vulnerability with lipid metabolism, inflammatory response and protease activity in patients with coronary artery disease. Methods: Patients who were diagnosed with coronary heart disease combined with carotid atherosclerosis in People's Hospital of Dongxihu District Wuhan City between April 2015 and October 2017 were selected and divided into vulnerable group and stable group according to ultrasonic judgment of carotid plaque vulnerability;the healthy volunteers who underwent physical examination during the same period were selected as the control group. The serum was collected to determine the contents of lipid metabolism, inflammatory response and protease activity indexes, and the peripheral blood was collected to determine the expression of inflammatory response indexes. Results: LDL-C, Lp(a), CXCL5, E-selectin, CatK and Meprin- levels in serum as well as ERK1/2, NF-κB and TNF-α expression in peripheral blood of stable group and vulnerable group were significantly higher than those of control group whereas ATGL, Omentin-1, Vaspin, PAI-1, TIMP1 and TIMP2 levels were significantly lower than those of control group;LDL-C, Lp(a), CXCL5, E-selectin, CatK and Meprin-levels in serum as well as ERK1/2, NF-κB and TNF-α expression in peripheral blood of vulnerable group were significantly higher than those of stable group whereas ATGL, Omentin-1, Vaspin, PAI-1, TIMP1 and TIMP2 levels were significantly lower than those of stable group. Conclusion: The changes of carotid plaque vulnerability in patients with coronary artery disease are closely related to the changes in lipid metabolism, inflammatory response and protease activity in the course of disease.

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.

Efficacy of Different Types of Self-expandable Stents in Carotid Artery Stenting for Carotid Bifurcation Stenosis

Both open and closed loop self-expandable stents were used in carotid artery stenting（CAS） for carotid bifurcation stenosis. We sought to compare the efficacy of two types of stents in CAS. The data of 212 patients treated with CAS（42 and 170 cases implanted with closed and open loop stents, respectively） for carotid bifurcation stenosis and distal filtration protection devices were retrospectively analyzed. Between closed and open loop stents, there were no significant differences in hospitalization duration, NIHSS score before and after the treatment, stenosis at 12 th month, and cumulative incidence of primary endpoint events within 30 days or from the 31 st day to the 12 th month; while there were significant differences in hemodynamic changes and rate of difficulty in recycling distal filtration protection devices. Use of open vs. closed loop stents for carotid bifurcation stenosis seems to be associated with similar incidence of complications, except for greater rate of hemodynamic changes and lower rate of difficulty in recycling the distal filtration protection devices.

Coronary atherosclerosis burden is not advanced in patients with β-thalassemia despite premature extracardiac atherosclerosis： a coronary artery calcium score and carotid intima-media thickness study

BackgroundThalassemic 病人表明 extracardiac 的增加的率脉管的复杂并发症和增加的颈动脉墙 intima 媒介厚度(cIMT ) ，而是冠的动脉疾病(CAD ) 的很低的流行。我们由估计冠的动脉钙(CAC ) 调查了粉瘤负担，在这些 patients.MethodsWe 的 cIMT 与 &#x003b2 检查了 37 个病人； -thalassemia 和 150 健康控制与多察觉者计算机断层摄影术(CT ) 和 ultrasonography 自愿决定 CAC 分数和 cIMT， respectively.ResultsPropensity 分数匹配(C 统计数值：0.88；95% CI：0.83-0.93 ) 导致了 27 个病人；严重 CAC 在 2 被观察(7.4%) 并且 0 &#x003b2； -thalassemia 病人和健康志愿者分别地(P = 0.5 ) 。中部的钙分数是 0 (0-0 ) 在 &#x003b2； -thalassemia 病人并且 0 (0-4 ) 在健康志愿者(P = 0.8 ) 。中部的 intima 媒介厚度在 &#x003b2 是更高的；与控制相比的 -thalassemia 病人组织[0.45 (0.06-0.65 ) 对 0.062 (0.054-0.086 ) ；P = 0.04 ] 有 &#x003b2 的 .ConclusionsPatients；与健康控制比较的 -thalassemia 使展览遭到类似的 CAC 分数和增加的 cIMT。我们的调查结果显示动脉粥样硬化在之间的前进的迥异的率冠并且在把支持借给流行病学的证据的这些病人的 extracardiac 动脉。

颈动脉狭窄合并冠心病同期外科治疗的疗效分析:单中心经验

目的总结同期颈动脉血运重建手术及冠状动脉血运重建手术治疗颈动脉狭窄合并冠心病患者的单中心临床经验。方法回顾性分析2008年1月至2020年1月中日友好医院心脏血管外科收治的54例颈动脉狭窄合并冠心病患者资料,其中同期行颈动脉内膜剥脱术(carotid endarterectomy,CEA)+冠状动脉搭桥术(coronary artery bypass grafting,CABG)38例,同期行颈动脉支架植入术(carotid artery stenting,CAS)+CABG 16例。结果手术成功率100%。围手术期内出现小卒中3例,短暂性脑缺血发作4例,术后短暂低血压8例,术后高灌注综合征3例,二次开胸3例,心肌梗死4例;无围手术期死亡病例。同期CEA+CABG组与同期CAS+CABG组的手术时间、术中出血量、围手术期输血量、神经系统并发症和循环系统并发症发生率差异均无统计学意义(P>0.05)。48例患者获得随访,随访时间29~140个月,平均(89.8±35.6)个月,因心肌梗死和心功能不全死亡患者各1例。结论同期CEA+CABG与同期CAS+CABG治疗颈动脉狭窄合并冠心病患者均安全有效。

TyG和TyG-BMI与冠心病患者颈动脉粥样硬化的相关性

目的分析冠心病患者颈动脉粥样硬化与TyG及TyG-BMI的关系。方法选取2021年1月~2022年12月天津市人民医院心内科收治并进行冠脉造影和颈动脉超声检查患者592例为研究对象。依据冠脉造影结果分为正常对照组(n=103)及CAD组(n=489)。收集患者临床资料,计算TyG指数和TyG-BMI水平。分析TyG和TyG-BMI与冠心病患者颈动脉病变程度的相关性。结果与正常对照组比较,CAD组TyG指数和TyGBMI水平明显升高(均P<0.01)。按照Gensini评分三分位数将患者分为三组,中分组(均P<0.05)和高分组(均P<0.01)TyG指数和TyG-BMI水平显著高于低分组。高分组TyG指数和TyG-BMI水平显著高于中分组(均P<0.01)。Spearman相关性分析显示TyG与TyG-BMI和Gensini评分呈现正相关,且TyG指数关联性更强(均P<0.01)。与颈动脉正常组相比,颈动脉粥样硬化组TyG指数更高(P<0.01),TyG-BMI更高(P<0.05)。二元Logistic回归分析发现年龄(OR=1.114,95%CI:1.05~1.18,P<0.01)与高血压(OR=2.913,95%CI:1.27~6.70,P<0.05)是颈动脉粥样硬化的独立危险因素),HDL-C(OR=0.108,95%CI:0.03~0.43,P<0.01)是保护因素。多元Logistic回归分析结果提示高水平TyG和TyG-BMI是颈动脉斑块形成的危险因素。以颈动脉正常为参照,排除混杂因素(如性别、年龄、BMI、收缩压、吸烟史、高血压病史、糖尿病史、药物服用情况)后,高TyG指数组CAD患者发生颈动脉斑块形成的风险是低TyG组的2.56倍,高TyG-BMI组发生颈动脉斑块的风险是低水平TyG-BMI组的4.35倍。Spearman相关性分析发现,TyG指数和颈动脉斑块厚度呈显著正相关(P<0.05),而TyGBMI和斑块厚度无相关。ROC曲线分析结果显示,TyG指数对冠心病患者合并颈动脉斑块形成具有较好的预测价值。结论TyG指数和TyG-BMI是冠心病患者颈动脉斑块形成的危险因素,且TyG指数对颈动脉斑块的预测价值优于TyG-BMI。

经颅多普勒超声微栓子监测评估PAS治疗颈动脉颈段易损斑块疗效的观察

目的探讨经颅多普勒超声(TCD)微栓子监测评估PAS(抗氧化、抗血小板、调脂治疗)治疗颈动脉颈段易损斑块的疗效。方法收集中国人民解放军联勤保障部队第九一〇医院2019年7月至2021年7月收治的采用PAS疗法进行治疗的颈动脉颈段易损斑块患者作为研究组(46例)。选取2015年6月至2019年6月该院收治的仅采用AS疗法(抗血小板、调脂治疗)治疗的颈动脉颈段易损斑块患者作为对照组(38例)。对2组患者治疗前后进行TCD微栓子监测,并评估斑块稳定性。结果治疗后研究组共检测出微栓子信号(MES)阳性患者1例,对照组共检测出MES阳性患者6例(P<0.05)。治疗后颈动脉内膜中层厚度(IMT)研究组低于对照组(P<0.05)。研究组治疗后IMT明显低于治疗前(P<0.05),对照组治疗前后IMT无明显变化(P>0.05)。随访1年,研究组缺血事件发生率显著低于对照组(P<0.05),且发生急性脑梗死患者的卒中严重程度轻于对照组(P<0.05)。研究组出现3例消化系统不良反应,不影响治疗及预后。结论PAS治疗颈动脉颈段易损斑块,有助于提高斑块稳定性,可以降低卒中发生风险,减轻卒中严重程度。

缺血性脑血管病血清尿酸水平与颈动脉不稳定斑块关系

目的 探讨缺血性脑血管病血清尿酸水平与颈动脉不稳定斑块关系。方法 选择60例缺血性脑血管病患者,其中,短暂性脑缺血发作30例(短暂性脑缺血发作组);脑梗死30例(脑梗死组),测定两组患者的血清尿酸水平,分析缺血性脑血管病血清尿酸水平与颈动脉不稳定斑块的关系。结果 短暂性脑缺血发作组的血清尿酸水平显著低于脑梗死组(P<0.05)。Logtisic回归分析显示,血清尿酸水平升高是缺血性脑血管病患者斑块发生的危险因素(P<0.05)。随着斑块面积增大,血清尿酸水平升高(P<0.05)。结论 缺血性脑血管病血清尿酸水平与颈动脉不稳定斑块关系密切,血清尿酸水平是患者斑块发生的独立危险因素,通过早期监测血清尿酸水平,可更好地评估颈动脉斑块的不稳定性,为疾病早期诊治提供基础。

血管内支架植入术治疗缺血性脑血管病颈动脉狭窄患者的临床效果分析

目的观察血管内支架植入术治疗缺血性脑血管病(ICVD)颈动脉狭窄患者的临床效果。方法选取行ICVD治疗的患者83例分为观察组43例和对照组40例,比较2组患者的血流动力学指标和颈内动脉血管狭窄程度、神经标志物与血管内皮功能、神经功能缺损程度、临床疗效和不良反应。结果2组患者经治疗后的血管收缩期峰流速(PSV)、舒张末期流速(EDV)和血管狭窄程度均呈下降趋势,且对照组的PSV、EDV和血管狭窄程度下降幅度均小于观察组,差异有统计学意义(P<0.05);2组患者治疗后的正五聚蛋白-3(PTX-3)、神经元特异性烯醇化酶(NSE)均有降低,血管扩张功能(FMD)和血管内皮生长因子(VEGF)均有提升,且观察组的PTX-3、NSE低于对照组,VEGF、FMD高于对照组,差异有统计学意义(P<0.05);治疗后2组患者的美国国立卫生研究院脑卒中量表(NIHSS)和改良爱丁堡-斯堪的纳维亚评分(MESSS)均降低,且对照组NIHSS评分和MESSS降低幅度小于观察组;对照组的临床总有效率为80.00%,低于观察组的97.67%,差异有统计学意义(P<0.05);观察组和对照组的不良反应发生率分别为2.33%和22.50%,差异有统计学意义(P<0.05)。结论血管内支架植入术能够有效提高ICVD患者的临床疗效,减轻血管狭窄程度,改善患者的认知功能,且具有较高安全性。

老年缺血性脑卒中患者颈动脉斑块特征及血液流变学与疾病分型及严重程度的关系

目的分析老年缺血性脑卒中患者颈动脉斑块特征及血液流变学与疾病分型及严重程度的关系。方法选择240例老年缺血性脑卒中患者为观察组,按疾病分型[完全前循环梗死(TACI)、部分前循环梗死(PACI)、后循环梗死(POCI)、腔隙性梗死(LACI)]和病情严重程度(轻度、中度、重度)对观察组患者进行二次分组;另选取60例老年健康体检者为对照组。检测受试者颈动脉斑块特征[颈动脉内膜中层厚度(IMT)、斑块数量、斑块最大长径、斑块性质]、血液流变学[红细胞沉降率(ESR)、红细胞比容(HCT)、血浆纤维蛋白原(Fib)、血浆黏度、全血黏度]指标,分析颈动脉斑块特征及血液流变学与疾病分型及严重程度的关系。结果观察组IMT、斑块数量、斑块最大长径、ESR、HCT、Fib、血浆黏度、全血黏度水平高于对照组,差异有统计学意义(P<0.05);LACI组IMT、斑块数量、斑块最大长径低于TACI、PACI、POCI组,稳定型斑块比率则更高,差异有统计学意义(P<0.05);LACI组ESR、HCT、Fib、血浆黏度、全血黏度水平低于TACI、PACI、POCI组,差异有统计学意义(P<0.05);轻度组IMT、斑块数量、斑块最大长径低于中度组和重度组,稳定型斑块比率高于中度组和重度组,中度组的IMT、斑块数量、斑块最大长径低于重度组,差异均有统计学意义(P<0.05);轻度组ESR、HCT、Fib、血浆黏度、全血黏度水平低于中度组和重度组,中度组上述指标低于重度组,差异有统计学意义(P<0.05)。结论老年缺血性脑卒中患者颈动脉斑块特征及血液流变学与疾病分型及严重程度有关,TACI、PACI、POCI型老年缺血性脑卒中患者的颈动脉斑块状态和血液流变学异常情况较LACI型患者更为严重。

彩色多普勒血流成像在缺血性脑血管病患者颈动脉狭窄评估中应用价值分析

目的:探讨彩色多普勒血流成像(CDFI)在缺血性脑血管病患者颈动脉狭窄评估中的应用价值。方法:回顾性分析2021年1月—2023年11月寿光市人民医院收治的125例缺血性脑血管病患者颈动脉数字减影血管造影(DSA)及CDFI检查结果,以DSA结果为金标准分析CDFI诊断颈动脉狭窄的灵敏度、特异度、准确度、阳性预测值、阴性预测值,并用Kappa检验验证CDFI与DSA诊断颈动脉狭窄的一致性;根据DSA结果显示的颈动脉狭窄情况将患者分为颈动脉狭窄组与正常组,比较两组患者颈动脉血搏动指数(PI)、阻力指数(RI)、舒张期血流速度(EDV)、收缩期峰值流速(PSV)。结果:DSA结果显示,125例患者中74例存在颈动脉狭窄,设为颈动脉狭窄组;51患者无颈动脉狭窄,设为正常组。CDFI检查结果显示,125例患者中73例存在颈动脉狭窄,以DSA结果为金标准,CDFI诊断颈动脉狭窄的灵敏度为97.30%、特异度为98.04%、准确率为97.60%、阳性预测值为98.63%、阴性预测值为96.15%,且Kappa检验结果显示,CDFI与DSA诊断颈动脉狭窄的一致性极好(Kappa值=0.950,P<0.05)。颈动脉狭窄组患者PI、RI高于对照组,EDV、PSV低于对照组,差异有统计学意义(P<0.05)。结论:CDFI在缺血性脑血管病患者颈动脉狭窄评估中的应用价值较高,便于临床更好地对患者进行治疗,促进患者病情好转。

颈动脉支架植入术联合规范脑血管病二级预防对颈内动脉颅外段重度狭窄患者的效果观察

目的探究颈动脉支架植入术联合规范脑血管病二级预防对颈内动脉颅外段重度狭窄患者认知功能影响的效果。方法选取2021年9月至2023年3月期间在济南市第三人民医院收治的68例颈内动脉颅外段重度狭窄患者,根据治疗方式不同将其分为对照组和观察组各34例。基础疾病治疗基础上,对照组采取规范的脑血管病二级预防,观察组完成颈动脉支架植入术,并坚持规范的脑血管病二级预防,比较两组精神状态、认知功能、不良情绪、日常生活活动能力及神经功能缺损评分情况。结果治疗后,两组患者的简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分均有所提高,且观察组高于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者的汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评分均有所下降,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者的日常生活能力评定量表(ADL)评分均有所提高,且观察组高于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者的神经功能缺损(NIHSS)评分均有所降低,观察组低于对照组,差异有统计学意义(P<0.05)。结论颈动脉支架植入术联合规范脑血管病二级预防能够显著改善颈内动脉颅外段重度狭窄患者的精神状态、认知功能、不良情绪、日常生活活动能力和神经功能缺损。这一治疗策略有助于提升患者的生活质量和康复效果。

颈动脉重度狭窄合并冠心病患者的临床危险因素分析

目的探究颈动脉重度狭窄合并冠状动脉粥样硬化性心脏病(冠心病,CHD)患者的临床危险因素。方法回顾性纳入2016年1月1日至2021年9月30日于首都医科大学附属北京安贞医院心血管内科、脑血管病科及神经外科就诊,接受侵入性脑动脉造影检查并提示至少1支颈动脉存在重度狭窄患者,根据合并冠心病诊断情况,分为合并冠心病组(n=654)与不合并冠心病组(n=464),比较两组患者的临床危险因素及生化指标差异,分析颈动脉重度狭窄合并冠心病患者的临床与生化危险因素。结果最终共纳入1118例颈动脉重度狭窄患者,其中颈动脉重度狭窄合并冠心病患者654例(58.5%)。与非CHD患者相比,合并冠心病患者具有更高比例的高血压、糖尿病、合并椎动脉/锁骨下动脉重度狭窄,以及更高的脂蛋白(a)[Lp(a)]与糖化血红蛋白水平,差异有统计学意义(P<0.05)。多因素回归分析结果显示,年龄、男性、高血压、重度锁骨下动脉狭窄、重度椎动脉狭窄、重度脑动脉狭窄、高Lp(a)以及高密度脂蛋白胆固醇(HDL-C)减低为颈动脉重度狭窄合并冠心病的独立危险因素(P<0.05)。在<60岁的人群中,危险因素以高血压为主;在>60岁的人群中,危险因素为男性、合并锁骨下动脉及椎动脉重度狭窄、高Lp(a)及低HDL-C。随累积危险因素的增加,颈动脉重度狭窄合并冠心病比值比(OR)予以增加,差异有统计学意义(P<0.05)。结论年龄、男性、高血压、合并锁骨下动脉/椎动脉/脑动脉重度狭窄、Lp(a)升高以及HDL-C减低为颈动脉重度狭窄患者合并冠心病的独立危险因素。危险因素在<60岁与>60岁人群中的分布存在差异。颈动脉狭窄合并冠心病风险随危险因素累积数量增加而升高。

慢性颈内动脉闭塞评估及治疗中国专家共识

随着医疗诊断技术的进步及我国老年人口的不断增加,慢性颈内动脉闭塞(CICAO)在临床上越来越常见。伴有严重血流动力学障碍的症状性CICAO患者有较高的再发缺血性卒中的风险,与CICAO慢性缺血相关的认知功能障碍也越来越受到重视。但是,目前临床上对于CICAO尚缺乏统一的评估和治疗方案。该专家共识对CICAO相关的最新临床研究进行总结,并结合国内相关领域专家的临床实践经验,对CICAO患者的评估、治疗及围手术期管理提出了针对性意见,以期进一步规范临床诊疗流程,提高国内神经病学医师对CICAO患者的诊治水平。