目的 探讨颈动脉支架置入成形术(CAS)治疗症状性颈动脉狭窄的临床疗效.方法 回顾性分析2011年10月至2015年5月采用CAS治疗的212例症状性颈动脉狭窄的临床资料.结果 212例中,顺利完成支架置入199例,置入支架共207个,同期椎动脉置入支架6例、颈总动脉置入支架2例.支架置入后造影显示支架定位准确,平均残余狭窄＜35%.颈内动脉成功率为93.9%(199/212);其中6例残余狭窄＜20%,占3.0%(6/199);4例残余狭窄40%~50%,占2.0%(4/199).9例存在严重血管迂曲及易损斑块,选择CEA治疗;1例为造影时发现狭窄部位有附壁血栓,需准备近端保护装置,择期手术,当天夜间出现脑栓塞.术后9例出现一过性头痛、头晕等症状,5例出现低血压及心动过缓,2例严重迷走反射,2例出现血管痉挛,1例脑出血死亡.结论 症状性颈动脉狭窄行CAS可取得显著的临床效果,且具有创伤小、恢复快、并发症少等特点,在严格控制指征、规范术中操作、合理的围手术期管理的前提下,可取得较理想的临床效果.

Objective To explore the value of the intraoperative duplex ultrasound be used in the carotid endarterectomy and the relationship between the different diagnostic performance and the neurologic outcomes.Methods Eighty-seven patients with serious internal carotid stenosis who performed the carotid endarterectomy(CEA) were examined by the intraoperative duplex ultrasound,then evaluated the interdependency between the performance and the Surgical final diagnosis.Results 42.5％ (37 of 87) of patients with intraoperative ultrasound examination showed abnormal results in which 76％ (28 of 37) were minor irregularity including small intimal flaps and minor residual plaques,meanwhile 24％ (9 of 37) of the them were remarkable abnormality among which 6 cases were repaired in the operation immediately.The perioperative incidence of neurological complications of the all 87 patients was 4.6 ％ (4/87) which including 2 cases with the postoperative cerebral hyperperfusion and other 2 cases who were suffered the cerebral infarction.Conclusions Intraoperative ultrasound is the right hand be used in CEA surgery,which was helpful in the assessing of abnormal situation happened in the operation and further more could repair them immediately.

Accumulating evidence shows that immune cells play an important role in carotid atherosclerotic plaque development. In this study, we assessed the association of 6 different natural killer T (NKT) cell subsets, based on CD57 and CD8 expression, with risk for development of carotid atherosclerotic plaque (CAP). Molecular expression by peripheral NKT cells was evaluated in 13 patients with high-risk CAP and control without carotid stenosis (n = 18). High-risk CAP patients, compared with healthy subjects, had less percentage of CD57+CD8− NKT cell subsets (8.64 ± 10.15 versus 19.62 ± 10.8 %; P = 0.01) and CD57+CD8int NKT cell subsets (4.32 ± 3.04 versus 11.87 ± 8.56 %; P = 0.002), with a corresponding increase in the CD57−CD8high NKT cell subsets (33.22 ± 11.87 versus 18.66 ± 13.68 %; P = 0.007). Intracellular cytokine staining showed that CD8+ NKT cell subset was the main cytokine-producing NKT cell. Cytokine production in plasma was measured with Bio-Plex assay. The expression levels of pro-inflammatory mediators (IFN-γ, IL-17, IP-10) were significantly higher in CAP patients as compared to that from controls. These data provide evidence that NKT cell subset compartment reconfiguration in patients with carotid stenosis seems to be associated with the occurrence of carotid atherosclerotic plaque and suggest that both pathogenic and protective NKT cell subsets exist.

Objective:To investigate the prevalence of periodontal pathogens in the subgingival plaque of patients with ischemic stroke,and the relationship between the distribution of periodontal pathogens and various degrees of chronic periodontitis.Methods:49 subgingival plaque samples of patients with IS and CP,40 subgingival plaque samples of patients with IS without CP,and 45 subgingival plaque samples of patients with CP were collected and their bacteria DNA was extracted.Four periodontal pathogens including Porphyromonas gingivalis (Pg),Tannerella forsythia (Tf),Fusobacteriu mnucleatum (Fn),Prevotella intermedia (Pi) were examined using the polymerase chain reaction (PCR) technique.Results:In the IS combined with CP group,the rates of periodontal bacteria were Pg 75.51％,Tf 97.96％,Fn 91.83％,Pi 67.35％.In the IS without CP group the rates of periodontal bacteria were Pg 37.50％,Tf 32.50％,Fn 27.50％,Pi 25.00％.In the CP group,the rates of periodontal bacteria were Pg 73.33％,Tf 91.11％,Fn 86.67％,Pi 66.67％.Fn rate was significantly different with degree of the severity in IS combined with CP group.Conclusions:The distribution of putative periodontal pathogens Pg,Tf,Fn and Pi is similar in the CP combined with IS group and CP group.Fn rate was significantly increased with degree of the periodontal severity in the IS combined with CP group.

Entrapment and fracture of carotid angioplasty and stenting hardware is a rare complication of percutaneous stenting procedures. We describe a case of a retained distal filter embolic protection device and guidewire in a 57-year-old male in Beijing, China. After unsuccessful attempts at removal via interventional methods, a second stent was deployed to secure the original hardware in situ, and the patient was discharged. He later experienced guidewire fragmentation in the carotid artery and aortic arch, with subsequent thrombus formation. We report partial removal of the guidewire and stent via carotid artery cutdown and open thoracotomy without complication. When efforts to retrieve stenting hardware are unsuccessful, it is never a suitable choice to leave them within the artery. We advocate for early surgical management of retained materials after unsuccessful carotid artery stenting. Furthermore, improved quality monitoring and assurance programs are needed to prevent such complications in the future.

2014年5月1日，美国心脏协会／美国卒中学会（ASA ）在《Stroke》杂志上发布了最新的“缺血性脑卒中和短暂脑缺血发作（T IA ）指南2014”。这个新指南上，对糖尿病和肥胖患者的脑卒中及T IA风险筛查，危险因素控制，主动脉弓部粥样硬化，颅外颈动脉狭窄，颅内脑动脉狭窄，心房颤动伴不明原因脑卒中患者长期监测，特殊人群应用新型抗凝剂，卵圆孔未闭等防治策略做了许多修改和更新。现重点对颈动脉支架成形术（CAS）的一些更新内容作一解读。

Objective To observe the value of real-time tissue elastography(RTE)in diagnosis of carotid vulnerable plaque.Methods Sixty patients with ischemic cerebrovascular diseases were enrolled.RTE images of plaque were estimated according Itoh's 5-point scale.After carotid endarterectomy(CEA),the plaques were examinated pathologically,and the results of RTE were compared with those of pathological examination.Results On ultrasonic elastogram,lipid necrotic core of plaque were green,fibers were blue,calcifications were blue and white,hemorrhage/thrombi were green,red green alternating or blue green alternating.Fibrous plaque,atheromatous plaque,plaque hemorrhage/thrombus and complicated plaque were in 12,24,9 and 15 cases,respectively.The sensitivity,specificity and accuracy of elastographic diagnosis for vulnerable plaques was 93.75%(45/48),83.33%(10/12),91.67%(55/60),positive predictive value and negative predictive value was 95.74%(45/47) and 76.92%(10/13),while positive likelihood ratio and negative likelihood ratios was 5.62 and 0.075,respectively.Conclusion RTE technique has good diagnostic value for carotid vulnerable plaques.

总结106例颈动脉内膜剥脱术患者的术前护理经验。认为术前护理的要点是重视术前教育，进行详细的护理评估，密切观察脑缺血症状，配合医生适当调节血压，预防心肌梗死，做好全脑血管造影术的护理。本组患者均顺利接受手术治疗，1例术后第8天脑出血，经治疗后好转出院；5例切口血肿，其中1例因血肿小行保守治疗，4例紧急施行血肿清除术，均顺利出院；4例术后出现心肌缺血或梗死征象，经内科治疗后好转出院，本组无死亡病例，手术效果满意。

目的 探讨颈动脉斑块贴近管腔无可视纤维帽低-无回声区(juxtaluminal black hypoechoic area,JBA)病理组织学基础及JBA预测脑卒中的临床价值.方法 采用灰阶中位数(gray-scale median,GSM)技术前瞻性研究颈动脉内膜切除术(carotid endarterectomy,CEA)患者80例待切除斑块JBA图像,并与术后病理组织学进行对照分析.结果 病理组织学可见颈动脉斑块JBA纤维帽极薄或不完整,斑块表面存在糜烂、溃疡、出血、血栓及脂质坏死组织.JBA-GSM值≤25组与JBA GSM值＞25组CEA患者脑卒中症状发生率存在明显统计学差异.结论 颈动脉粥样硬化斑块JBA对于预测脑卒中风险具有重要的临床意义.

斑块是怎样"炼"成的 斑块,人体血管内的"不定时炸弹"和"隐形杀手",使我们时刻处于缺血性疾病的危险之中,惶惶不可终日.斑块究竟是怎样形成的呢?冰冻三尺,非一日之寒.斑块的形成,是多种因素在长年累月的时间里共同"炼"成的,下面,就以颈动脉斑块为例,以"三ji(即:积、激、击)理论"详解斑块的"炼就"过程.

目的 探讨与经股动脉途径(TFA)相比,经桡动脉途径(TRA)行血管内支架成形术(PTAS)治疗椎动脉起始部狭窄的效果及安全性.方法 25例椎动脉起始部狭窄患者经桡动脉途径(TRA组10例)和经股动脉途径(TFA组15例)行PTAS,比较两组治疗时间、效果及随访结果.结果 TRA组术中时间、术后卧床时间小于TFA组;随访均无脑血管事件发生.结论 经TRA行PTAS治疗椎动脉狭窄性脑血管病技术成功率100％,能减少卧床时间和穿刺部位相关并发症.

Objective: Discussing assessment of diagnosis internal carotid artery occlusion by contrast enhanced ultrasound(CEUS).Methods: The project applies CEUS and digital subtraction angiography(DSA) to 11 patients with probable internal carotid artery occlusion,thus the value of CEUS is assessed in occlusion diagnosis.Results: Study examines 11 internal carotid arteries from 10 patients.There are 6(6/11) severe stenosis and 5(5/11) occlusion as the result of DSA.In addition,CEUS explains that 1(1/11) are occlusion and 10(10/11) are severe stenosis with the distal arteries unobstructed.Conclusion: CEUS is employed as an important imaging tool with noninvasive before DSA test,which has ability in assessing internal carotid artery occlusion.Moreover,CEUS shows therapeutic opportunities to some of the patients and provides references to clinical treating plans.

脑中风固然比死亡还可怕,但目前在我国更为可怕的是下面3种情况. 1认知甚少 在中国,提起脑中风,几乎人人都知道这个病.但大多数的民众并不知道脑中风是什么原因引起的;部分医师尽管知道其中的原因,却不全知道如今有哪些办法可以防治脑中风;对于多数掌握技术并知道如何治疗的人,又不知道如何推广.简而言之,就是知其病,而不知其因;知其因,而不知其法;知其法,却不知其道.于是,在国内就存在以下的事实.

Objective:To detect periodontal bacteria in carotid atheromatous plaque.Methods: 15 pieces of carotid atheromatous plaque samples were collected from endarderectomy patients.Carotid atheromatous plaque specimens were examined using the polymerase chain reaction(PCR) technique by means of specific primers for periodontal bacterias including Porphyromonas gingivalis(Pg),Aggregatibacter actinomycetemcomitans(Aa),Tannerella forsythia(Tf),Prevotella intermedia(Pi),Fusobacterium nucleatum(Fn).Results: PCR amplification of bacterial 16S rDNA indicated the presence of Fn in 4 samples,Pg in 2 samples,and one samples detected both Fn and Pg.Aa,Tf,Pi DNA was not detected by PCR in any of the carotid samples.Conclusion: Periodontal pathogens could have an effect on the occurrence and development of carotid atherosclerosis.

动脉粥样硬化是一种基因和环境共同作用导致的复杂疾病,DNA甲基化是一种重要的表观遗传修饰调控机制,由环境因素导致,并可通过有丝分裂遗传下去.目前已有研究表明,DNA甲基化在动脉粥样硬化疾病的发生发展过程中起到至关重要的作用.本文综述了DNA甲基化在动脉粥样硬化方面的研究进展.

眼缺血综合征是眼前后节及眼动脉供应的其他眼眶组织的一种严重慢性缺血表现.颈内动脉狭窄或阻塞是其最常见的致病原因.治疗时应结合患者全身情况及眼部表现选择适当的治疗方式.具体措施包括针对眼部缺血及其并发症的局部非手术治疗,以改善颈动脉血液循环为主的手术治疗,以及针对高血压、糖尿病、血脂异常及冠心病等全身疾病的相关治疗。

目的 探讨手术治疗颈动脉狭窄的方法.方法 确诊为颈动脉狭窄患者27例,全麻下行颈动脉内膜剥脱术,所有病例均采用转流管维持脑部供血,剥离颈动脉斑块.结果 27例患者术后均恢复良好,脑缺血症状有明显改善,术后未出现死亡及脑卒中事件;术后随访6个月未出现严重的并发症.结论 颈动脉内膜剥脱术对预防和治疗缺血性脑卒中安全有效.

Objective To explore the value of intraoperative color Doppler flow imaging in carotid endarterectomy.Methods Twenty-one patients with serious internal carotid stenosis underwent carotid endarterectomy(CEA).The intraoperative color Doppler flow imaging was applied to confirm the positions of carotid plaques,the dimensions of pathological changes,and the flaps or the thrombosis in carotid artery.According to Panetton's standards,the outcomes of color Doppler flow imaging were classified as normal,minor or significant abnormal.Results Fourteen strip high echo were found in 9 patients after operation,including 12 minor abnormalities(intimal flaps less than 3 mm) and 2 significant abnormalities(one was the implanted adventitia in artery,another was a thrombus with strip form).These 2 significant abnormalities were managed with operation,while the other 12 minor abnormalities were not treated but then recovered 3 days after operation.Conclusion Application of color Doppler flow imaging during CEA helps to confirming the position of carotid plaques,observing dimensions and changes and the level of stenosis,as well as discovering lesions and complications,therefore benefits to decrease stroke and death after operation.

Objective To observe the perioperative complication in hospitalized cases in intensive care unit after carotid endoarterectomy(CEA) and vascular patch neoplasty,and to explore the beneficial postoperative administration strategy.Methods Hospitalized cases in our cerebral vessel centre who were performed with CEA and vascular patch neoplasty from October 1,2008 to October 1,2009 were selected,and the general data,perioperative complication,drug therapy and therapeutic effect in ICU were recorded.Results 25 cases were included,the average age was(67.36±8.70)years old.The average stay in ICU was(4.48±7.18)days,the average stay in hospital was(35.76±23.14)days.20 cases(80%) had postoperative hypertension,among them 7 cases(28%) had critical hypertension(systolic blood pressure ≥180 and/or diastolic blood pressure≥110mmHg),2 cases(8%) had stroke(one complicated with ophthalmic artery embolism,the other complicated with cerebral infarction),14 cases(56%) had hyperglycaemia,2 cases(8%) had cervical hematoma(1 case was cured by operation),2 cases(8%) had facial hypesthesia.During ICU,14 cases(56%) were cured,9 cases(36%) were relieved,2 cases(8%) were no-relieved,no one was dead.The total effective rate was 92%.Conclusion Some severe complication risk should be complicated in cases with CEA and tissue-engineering vascular patch neoplasty,the recent therapeutic effect was good,and the precise stratgy of perioperative general administration should be emphasized.

Objective To summarize the short-term efficacy and applied experience of carotid endarterectomy(CEA) in symptomatic carotid artery stenosis.Methods A total of 40 patients with symptomatic carotid artery stenosis to receive CEA were recruited in this study.All the patients had clinical symptoms of cerebral ischemia.The carotid atheromatous plaque and carotid stenosis were first screened by carotid Doppler ultrasonography and transcranial Doppler (TCD), then conformed respectively through enhanced magnetic resonance angiography (CE-MRA),CT angiography (CTA),digital subtraction angiography (DSA).The degrees of carotid artery stenosis of extracranial segment were all equal to or more than 70%.In them,5 cases combined ulcer lesion,and 1 case combined one-lateral internal carotid stenosis and another lateral internal carotid complete occlusion.CEA operation was carried out under general anesthesia using endotracheal intubation combined cervical plexus block.Carotid temporal shunting tube was used in all cases.Patch angioplasty was performed in 32 cases.Results No perioperative deaths happened.Thirty-one cases had significant improvement of ischemic cerebral symptom,and 9 cases had certain improved.Postoperative hyper-perfusion syndrome and hemodynamic instability happened separately in 1 case.The complications of perioperative period of symptomatic carotid artery stenosis were 5.0% consistent with the standard of American Heart Association (AHA) equal to or less than 6%.All cases were followed up.No vascular restenosis happened during re-examination of double lateral cervical vascular ultrasonography at 6 weeks and 3 months after operation.Conclusions CEA is a safe and effective treatment method for symptomatic carotid artery stenosis.