目的 探讨冠状动脉重度狭窄合并颈内动脉重度狭窄(CCASS)的影响因素.方法 回顾性连续纳入2013年5月至2015年12月于首都医科大学附属北京安贞医院神经介入科诊治的冠状动脉粥样硬化性心脏病(CHD)合并颈内动脉粥样硬化性狭窄患者282例,均同期行心脑联合造影.根据颈内动脉粥样硬化性狭窄程度和冠状动脉粥样硬化性狭窄程度的不同,分别将282例患者分为非重度狭窄组和重度狭窄组,对各两组患者临床特征(年龄、性别、吸烟、饮酒、既往脑梗死、高血压病、糖尿病、高脂血症)进行比较,并进一步对颈内动脉重度狭窄和冠状动脉重度狭窄的影响因素进行多因素Logistic回归分析.依据同期心脑联合造影的结果,参照北美症状性颈动脉内膜切除术试验(NASCET)标准评估冠状动脉、颈内动脉狭窄程度,并分为轻度狭窄(狭窄率<50％)、中度狭窄(50％≤狭窄率<70％)、重度狭窄(狭窄率≥70％).将任一侧颈内动脉重度狭窄且同时满足左主干或左侧前降支或左侧回旋支或右侧冠状动脉中任一血管重度狭窄定义为CCASS,并依此将282例患者分为CCASS组和非CCASS(轻、中度狭窄)组,分别为78例和204例,对两组患者临床特征进行比较.以发生CCASS为因变量,将单因素分析中P<0.05的变量进一步行多因素Logistic回归分析,以分析CCASS的影响因素.结果 (1)282例CHD合并颈内动脉粥样硬化性狭窄患者中,颈内动脉重度狭窄107例(37.9％),冠状动脉重度狭窄170例(60.3％),CCASS 78例(27.7％).(2)CHD合并颈内动脉粥样硬化性重度狭窄影响因素的多因素Logistic回归分析显示,年龄增加(OR=1.088,95％CI:1.054～1.123,P<0.01)、吸烟(OR=3.090,95％CI:1.720～5.530,P<0.01)、既往脑梗死(OR=2.646,95％CI:1.376～5.086,P=0.004)和糖尿病(OR=1.790,95％CI:1.010～3.170,P=0.046)为颈内动脉重度狭窄的独立危险因素,性别、饮酒、高血压病、高脂血症均非颈内动脉重度狭窄的影响因素(均P>0.05).(3)CHD合并颈内动脉粥样硬化性狭窄患者冠状动脉粥样硬化性重度狭窄影响因素的多因素Logistic回归分析显示,年龄增加(OR=1.057,95％CI:1.028～1.087,P<0.01)、糖尿病(OR=2.170,95％CI:1.170～3.950,P=0.02)为冠状动脉重度狭窄的独立危险因素,男性发生冠状动脉重度狭窄的风险降低(OR=0.400,95％CI:0.190～0.870,P=0.02);吸烟、饮酒、既往脑梗死、高血压病、高脂血症均非冠状动脉重度狭窄的影响因素(均P>0.05).(4)CCASS组患者年龄高于非CCASS组[(65±8)岁比(59±10)岁,t=-6.72,P<0.01],男性、吸烟、既往脑梗死、高血压病、糖尿病、高脂血症比例高于非CCASS组[84.6％(66/78)比70.6％(144/204),χ2=5.83,P=0.016;70.5％(55/78)比52.0％(106/204),χ2=7.92,P=0.005;34.6％(27/78)比17.2％(35/204),χ2=10.27,P=0.002;80.8％(63/78)比62.3％(127/204),χ2=8.79,P=0.003;42.3％(33/78)比26.5％(54/204),χ2=6.63,P=0.010;30.8％(24/78)比18.6％(38/204),χ2=4.85,P=0.028],组间差异均有统计学意义.两组饮酒比例的差异无统计学意义(P>0.05).(5)CHD合并颈内动脉粥样硬化性狭窄患者CCASS影响因素的多因素Logistic回归分析显示,年龄增加(OR=1.080,95％CI:1.045～1.115,P<0.01)、吸烟(OR=2.460,95％CI:1.340～4.513,P=0.004)、既往脑梗死(OR=2.103,95％CI:1.109～3.988,P=0.023)为CCASS的独立危险因素,男性、饮酒史、高血压病、糖尿病、高脂血症均非CCASS的影响因素(均P>0.05).结论 年龄增加、有吸烟史和脑梗死病史可增加CCASS的发生风险.

目的:探讨桡动脉TRA(TRA)与股动脉(TFA)穿刺入路对心脑血管联合造影患者围手术期并发症以及住院时间的影响.方法:回顾性收集2013年5月至2015年8月期间,北京安贞医院神经介入科诊治的心脑血管联合造影术225例.根据穿刺途径的不同分为桡动脉组和股动脉组.对比两组间危险因素、围手术期并发症、住院时间(LOS).用倾向性评分匹配危险因素后再次对比两组间的并发症和LOS.结果:①本研究中共纳入225例患者,其中男性73.8％(166/225例),年龄32～80岁,平均年龄(59.32±9.97)岁.平均住院时间5(2,7)d.桡动脉组占76.4％(172/225例),股动脉组23.6％(53/225例).②围手术期不良事件总发生率1.8％(4/225例),桡动脉组2例(术后消化道出血1例,急性缺血性卒中1例);股动脉组2例,均为穿刺点血肿;组间比较差异无统计学意义(3.77％vs.1.16％,P=0.209).上述不良事件经处理后临床好转或痊愈.两组均无死亡病例.用倾向性评分匹配(PSM)的方法,调整年龄、脑梗死、高血压、糖尿病和冠心病后,筛选出TRA和TFA组各40例患者.两组的不良事件差异无统计学意义(2.5％vs.5.0％,P=0.556).TRA组的患者中,低LOS的患者占比较大(80％vs.57.5％,P=0.030).结论:对于心脑联合造影的患者来说,TRA和TFA两组之间围手术期不良事件间差异无统计学意义;TRA可降低心脑联合造影患者的LOS.

目的 探讨远端桡动脉入路(dTRA)穿刺在神经介入诊疗中的安全性和可行性.方法 回顾性分析2020年10月至2022年3月在北京安贞医院接受dTRA选择性脑血管造影或支架植入术诊疗患者一般资料(年龄、性别、危险因素等)、临床资料(入手术室至穿刺成功时间、手术时间、X线辐射时间、总辐射剂量)、手术相关并发症、穿刺相关并发症.结果 共纳入患者34例,其中男26例,女8例,年龄(61.6±9.0)(33～74)岁.dTRA脑血管造影技术成功率为100％.入手术室至穿刺成功时间为(23.1±10.1)(9～50)min,手术时间为(46.1±27.4)(14～154)min,X线辐射时间为(17.7±12.3)(6～69)min,总辐射剂量为(671.6±334.3)(70～1573)mGy.造影完成后17例同期接受介入治疗,其中1例椎动脉起始段狭窄患者造影后拟行椎动脉支架植入术,因路径迂曲改为股动脉穿刺.dTRA行介入治疗技术成功率为94.1％(16/17).术后24 h 1例颈动脉支架植入术患者出现急性支架内闭塞,急诊取栓后美国国立卫生研究院卒中量表(NIHSS)评分为0分.术后患者未出现穿刺点淤血、出血、血肿及桡动脉闭塞.结论 dTRA行神经介入诊断和治疗安全可行.

目的:评价Enterprise 2支架在重度动脉粥样硬化性颅内动脉狭窄患者治疗中的安全和有效性.方法:回顾性分析2019年4月至2021年11月,于首都医科大学附属北京安贞医院神经介入科采用Enterprise 2支架进行治疗的21例重度动脉粥样硬化性颅内动脉狭窄患者资料(规范药物治疗下仍有缺血性卒中发作),所有患者术前行数字减影全脑血管造影以明确诊断,术后30d、6个月随访,主要终点事件定义为术后30d内发生的短暂性脑缺血发作(TIA)、出血性或缺血性脑卒中、任何原因引起的死亡.结果:21例患者支架置入成功率100％,支架置入后责任血管狭窄率由(88.66.7)％降为(21.8 10.1)％,差异有统计学意义(t=35.12,P＜0.001);主要终点事件发生率为4.8％,术后6个月随访支架内再狭窄发生率为5.0％.术后6个月内TIA发生率5.0％,无缺血性脑卒中及死亡病例.结论:Enterprise 2支架在规范药物治疗效果不佳、血管病变复杂的重度动脉粥样硬化性颅内动脉狭窄患者的治疗中安全有效,但仍需长期随访、多中心随机对照研究加以验证.

目的:观察评估Neuroform EZ支架辅助弹簧圈栓塞治疗颅内动脉瘤的有效性与安全性.方法:回顾性分析本中心 2019年4月至2020年7月,采用Neuroform EZ支架辅助栓塞治疗的颅内动脉瘤患者资料,共纳入患者38例.所有患者术前行数字减影全脑血管造影(DSA)以明确诊断,术后即刻和术后6个月复查DSA造影,评估动脉瘤栓塞情况.结果:38例患者共39枚动脉瘤,共置入支架40枚,支架置入技术成功率100％,术后即刻动脉瘤完全闭塞率(Raymond Ⅰ级栓塞)为56.4％(22/39),术后6个月随访时,动脉瘤的完全闭塞率为79.5％(31/39),发现载瘤动脉再狭窄1例(2.6％).结论:Neuroform EZ支架辅助弹簧圈栓塞治疗颅内动脉瘤具有良好的有效性与安全性,但仍需长期随访和扩大样本量加以验证.

Objective:To investigate the feasibility and safety of submaximal balloon dilation and to perform small-diameter stent for symptomatic carotid artery severely stenosis before coronary artery bypass grafting(CABG).Methods:From January 2016 to December 2019, 30 patients of the Department of Neurointervention in Beijing Anzhen Hospital with symptomatic carotid artery stenosis(≥70%) and the left main trunk or triple-vessel of coronary artery disease were analyzed retrospectively. General information, clinical characteristics, and imaging data of all cases were collected. All patients underwent submaximal balloon dilation and small-diameter stent implantation. Preoperative comorbidities or risk factors included hypertension 23 cases(76.7%), diabetes 10 cases(33.3%), hyperglycemia 14 cases(46.7%), moking 13 cases(43.3%). Left main trunk disease 6 cases(20.0%), three-vessels disease 24 cases(80.0%), mitral regurgitation 1 case(3.3%), stable angina 25 cases(83.3%), myocardial infarction 8 cases(26.7%), cerebral infarction 24 cases(80.0%) and transient ischemia attack(TIA) 6 cases(20.0%) caused by ipsilateral carotid artery stenosis. The median National Institutes of Health Stroke Scale(NIHSS) score was 2(0-3), and the median modified Rankin Scale(mRS) score was 1(0-1) before the operation. The mean interval between carotid artery intervention and CABG was(23.4±8.2)days.Results:29 cases(96.7%, 29/30) underwent CAS-CABG operation successfully. In one case of carotid artery extreme tortuosity, the emboli protective device could not place the distal carotid artery. In the operative procedure, 27 cases(90.0%, 27/30) underwent with 3mm diameter balloon, only 3 cases(10.0%) with 3 mm balloon after pre-dilatation with 2 mm diameter balloon because of severely high-grade stenosis(99%). 25 cases(83.3%) with 7mm diameter stents and 5 cases(16.7%) with 6 mm diameter stents, including 22 cases(73.3%) with a closed-cell stent and 8 cases(26.7%) with an open-cell stent. In the perioperative period, the heart rate of two patients was lower than 50 BPM during operation and returned to normal after using atropine immediately. Another patient presented with chest tightness during interventional therapy. TNI elevation was examined urgently. After oxygen inhalation and intravenous infusion of Nitroglycerin, the patient's symptoms improved rapidly. No cardiac and cerebrovascular complications occurred during the perioperative period of CABG, no cardiac-related complications occurred within 30 days of follow-up, one case of TIA and 1 case of cerebral infarction. After intensive anti-platelet aggregation and lipid-lowering treatment, two patient's symptoms improved. There were no death cases in all patients during carotid artery interventional therapy, perioperative CABG and 30-day follow-up. Thirty days later, we performed a clinical follow-up of 23 cases, median 4.5(3.0-7.9) months, mRS Score Median 1(0-1). One patient presented with TIA, any patient had no symptoms of the cardiac or nervous system. Image follow-up of 17 cases, median 3.5(2.8-4.5) months, carotid artery ultrasound showed in-stent restenosis(stenosis rate>50%) in 1 case, the patient was asymptomatic restenosis, continue treatment of aggressive anti-platelet and lipid-lowering drugs.Conclusion:Submaximal balloon dilation and performing small-diameter stent for symptomatic carotid artery severely stenosis before CABG is safe and feasible, which could not only reduce the incidence of vagus reflex resulted in acute coronary syndrome during carotid artery stenosis intervention but also morbidity of acute ischemic stroke events during CABG.

目的:探讨Envoy DA远端通路导管在颅内血管内治疗通路建立的有效性及安全性.方法:回顾性分析2019年6月至12月,首都医科大学附属北京安贞医院神经介入科连续使用Envoy DA导管,行症状性颅内动脉硬化性狭窄、颅内未破裂动脉瘤、硬脑膜动静脉瘘及颅内动静脉畸形血管内治疗通路建立患者42例的病例资料,记录患者一般临床资料、Envoy DA导管到位血管的部位及手术相关并发症等.结果:42例患者中,未破裂颅内动脉瘤29例,症状性颅内动脉粥样硬化性狭窄10例,硬脑膜动静脉瘘2例,颅内动静脉畸形1例.Envoy DA导管到达颈内动脉岩段垂直段24例(77.4％),岩段水平段3例(9.6％),鞍前段2例(6.5％),海绵窦段2例(6.5％);后循环病变100％到位于椎动脉V2段及以远部位.2例DAVF及1例AVM Envoy DA导管到位于颈外动脉起始处.术后出现1例非导管相关的缺血并发症.4例(9.5％)因Envoy DA导管在颈内动脉操作时出现痉挛,术中观察5 min后,血管痉挛完全缓解.结论:Envoy DA导管可安全建立颅内血管疾病的通路建立,为颅内不同血管疾病血管内治疗提供了稳定和安全的操作路径.

目的 探讨经同期椎动脉造影和冠状动脉造影证实的椎动脉狭窄与冠状动脉狭窄之间的相关性.方法 纳入2014年1月至2015年8月于首都医科大学附属北京安贞医院同时行椎动脉造影和冠状动脉造影的173例患者的临床资料.根据椎动脉狭窄的程度将患者分为椎动脉轻度狭窄组(狭窄＜50％,122例)和椎动脉重度狭窄组(狭窄≥50％,51例),分析椎动脉狭窄的危险因素.根据患者冠状动脉狭窄情况,将冠状动脉狭窄的患者分为冠状动脉轻度狭窄组(狭窄＜70％,58例)和冠状动脉重度狭窄组(狭窄≥70％,115例),分析冠状动脉狭窄的危险因素.对患者椎动脉和冠状动脉狭窄的具体情况进行统计分析,并探讨二者之间的相关性.结果 统计结果显示年龄、男性、高血压、冠心病(冠状动脉粥样硬化性心脏病)是椎动脉狭窄和冠状动脉狭窄的共同危险因素.椎动脉重度狭窄组总的冠状动脉重度狭窄患者比例以及左前降支、左回旋支、右冠状动脉重度狭窄患者比例明显高于椎动脉轻度狭窄组[80.4％(41/51)比60.7％(74/122)、66.7％(34/51)比42.6％(52/122)、47.1％(24/51)比28.7％(35/122)、54.9％(28/51)比32.8％(40/122)],差异均有统计学意义(均P＜0.05).结论 椎动脉狭窄和冠状动脉狭窄的危险因素基本相同.椎动脉狭窄和冠状动脉狭窄之间存在统计学相关性,对椎动脉狭窄的筛选可以为冠状动脉评估提供依据.

Objective: Previous studies have demonstrated a strong association between carotid artery stenosis (CAS) and coronary artery stenosis disease (COAS). However, prior evaluated methods are non-invasive examinations. This study was aimed to access the relationship between CAS and COAS by the means of angiography. Methods: This is a single-center, retrospectively reviewed study based on digital subtraction angiography (DSA) of carotid artery and coronary artery angiography (CAG). We collected a total of 231 patients undergoing DSA and CAG at the same-day between June 2013 and May 2015. The patients were stratified according to the degree of CAS and COAS, mild stenosis <50%, moderate stenosis 50-69%, severe stenosis 70-99%, occlusion 100%. The correlation of CAS with COAS, as well as the risk factors, was analyzed. Results: A total of 231 patients was enrolled in this study, male 71.9% (166/231). The age ranges from 32 to 80, mean age 60.06 ± 9.98. Of these patients, 79 patients were severe CAS and 128 patients were severe COAS. Statistical analysis demonstrated that the independent risk factors of severe COAS ≥70%, were age, sex, previous cerebral infraction, coronary heart diseases, and coronary artery surgery. CAS was associated with COAS (Spearman r = 0.333, P < 0.01). The more serious the CAS, the more involved COAS (Kendall's tab-b = 0.294, p < 0.01). Conclusions: The DSA confirmed CAS was associated with CAG confirmed COAS. The heavier the CAS is, the more the number of the affected coronary artery.

Objective To analyze the risk factors and etiological classification in young patients with cerebral infarction.Methods From January 2010 to December 2018,5 120 patients with acute cerebral infarction were admitted to neurology ward of Beijing Anzhen Hospital,Capital Medical University.Among them,337 young patients and 337 matched (1:1) middle-aged and old patients were selected.Age,sex,smoking,alcohol consumption,comorbidities of diabetes,dyslipidemia,hypertension,heart disease,stroke,hyper-homocysteine (Hcy) and sleep apnea syndrome were recorded.Risk factors and etiological types of cerebral infarction were analyzed.Results Prevalence rates of cerebral infarction risk factors in young patients from high to low were male,hypertension,smoking history,hyperlipidemia,history of alcohol consumption,hyper-Hcy,diabetes,heart disease history,stroke/family history,hyperuricemia,sleep apnea syndrome and migraine.Prevalence rates of cerebral infarction risk factors in middle-aged and old patients from high to low were hyperlipidemia,hypertension,male,smoking history,diabetes,heart disease history,stroke/family history,history of alcohol consumption,hyper-Hcy,hyperuricemia,sleep apnea syndrome and migraine.Proportions of male,smoking history,history of alcohol consumption and hyper-Hcy in young patients were higher while the proportions of hypertension,diabetes,hyperlipidemia,heart disease history,stroke/family history were lower than those in middle-aged and old patients [81.9％ (276/337) vs 70.3％ (237/337),64.4％ (217/337) vs 49.3％ (166/337),38.3％ (129/337) vs 23.7％ (80/337),37.4％ (126/337) vs 18.4％ (62/337);66.2％ (223/337) vs 78.9％ (266/337),25.2％(85/337) vs 40.4％ (136/337),49.3％ (166/337) vs 81.0％ (273/337),16.3％ (55/337) vs 37.7％ (127/337),12.5％ (42/337) vs 32.6％ (110/337)] (all P ＜ 0.05).Atherosclerosis type of cerebral infarction took the highest ratio among young patients;small artery occlusion type accounted for 32.0％ (108/337);unexplained type accounted for 12.8％ (43/337);cardiogenic type accounted for 10.1％ (34/337).Males took a large ratio in young patients with unexplained type of cerebral infarction.Among middle-aged and old patients,atherosclerosis type and small artery occlusion type of cerebral infarction accounted for high ratios.Conclusions Young men are more likely to suffer from cerebral infarction than women.Cerebral infarction in young adults are associated with various risk factors.Atherosclerosis type of cerebral infarction is the most common etiological type.It is of great significance for the prevention and treatment of young stroke to strengthen health education on smoking and alcohol cessation,promote healthy diet and raise the awareness of stroke risk factors among young people.

1876年,James Paget 首先报道6例局限性骨重建异常的病例,后命名为 Paget 骨病,也称畸形性骨炎或变形性骨炎(osteitis deformans)。其以骨重建增加、骨肥大、骨结构异常为特征,可导致骨痛、畸形和骨折发生。严重者可出现心血管和神经系统等并发症[1]。当累及骨盆时,部分患者可能被误认为血管瘤,目前国内外未见类似报道。本文报道1例患者误诊为髂骨血管瘤10余年,治疗效果欠佳,后经本科确诊为 Paget 骨病,本文予以报告。

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 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 investigate the secondary prevention of ischemic stroke drug treatment compliance and impact of anti-platelet drug compliance factors.Methods From August 2007 to September 2007,ischemic stroke or TIA patients who were admitted into internal medicine of neurology wards of 21 Hospitals in Beijing,a total of 541 recurrent stroke patients who were analyzed,retrospectively.Results There were 541 recurrent stroke patients.Uses of antiplatelet,antihypertension,antidiabetic and lipid-lowering therapy 58.4%,82.3%、85.3% and 14.2%,respectively.Age≥60(P=0.011),retirement (P=0.021),history of stroke (P<0.001),history of angina (P=0.001),history of myocardial infarction (P=0.037) and history of hypertension(P=0.016)was associated with anti-platelet drug compliance.Conclusions The present investigation has revealed a low drug compliance for secondary prevention of ischemic stroke,suggesting that the current status of secondary prevention of recurrent stroke is far from ideal.

Objective: A series of research works had proven that high-resolution magnetic resonance imaging (MRI) was an effective tool to identify the morphological appearance of atherosclerotic vulnerable plaque. We performed further study to compare ex vivo vascular morphology with MRI and histological examination using the specimens of carotid endarterectomy and femoral artery (FA) prosthetic reconstruction, and described the detailed histology and immunohistochemistry features ofplaque.Methods: Eight consecutive patients (five males, mean age 67.4 years) who were recruited into our study had high-grade stenosis or occlusion of carotid artery and FA (70 to 100%). Four patients accepted carotid endarterectomy and others underwent FA prosthetic reconstruction.Results: The high level of accuracy was shown in classification of the plaque type. The sections of plaques detected by MRI were classified as follows: 12 (22.2%) were modified American Heart Association (AHA) type III, 11 (20.4%) were type IV-V, 26 (48.2%) were type VI and 5 (9.3%) were type VII. According to the histological observations, the overall accurate rate by MRI showed a high level accuracy of 90.7% (49/54). Immunohistochemistry of cellular components in plaque shoulder demonstrated that CD68-positive macrophages were strongly dominated along the arterial wall. Reduced expression of smooth muscle actin (SMA)-positive smooth muscle cells were detected in the fibrous cap of atheroma. CD31 stain showed the increased presence of CD31-positive neomicrovessels.Conclusions: Atherosclerosis is a systematic disease that can involve whole body vascular beds. Noninvasive high-resolution MRI will provide useful information in morphological studies of the arterial walls and classification of the plaque type.

Objective To determine if adopt ABCDE strategies can maintain high medication coincidence rates after discharge from hospital.Methods From August 2007 to Dec 2007,a total of 1166 ischemic stroke or TIA patients were admitted into neurology wards of 21 hospitals in Beijing. Status of secondary prevention of stroke was analyzed by software SPSS 11.5,focusing on the compliance rate of medication in antiplatelet,antihypertension,antidiabetes and lipid-lowering therapy in hospital and discharge from hospital.Results There were 541 recurrent stroke patients, antiplatelet therapy rate in them was 58.4% ,antihypertension,antidiabetes and lipid-lowering therapy rates were 82.3%,85.3% and 14.2% respectively.There were 1166 patients discharged. Of them,1012 completed 90-days and six-months follow-up,and 981 completed one-year follow-up.The compliance rate of medication in antiplatelet,antihypertension,antidiabetes and lipid-lowering therapy was kept at a high level.Conclusion The status of secondary prevention of recurrent stroke can not be optimistic.Adopting ABCDE treatment strategy to carry out standard intervention for the admitted ischemic stroke/TIA patients significantly narrows the secondary prevention gap between evidence-based medicine and clinical practice,and makes medication compliance rate at a high level after discharge.

Objectives To investigate the internal association between apoptosis and Bax/Bcl-2 expression, and explore the relationship between the gene expression and atherosclerotic plaque stability. Methods Totally 8 human femoral artery and 5 human carotid plaque specimens obtained during endarterecctomy were fixed,decalcified,cut at 4 mm intervals and routinely processed for HE sections.All blocks were divided into stable plaques and unstable plaques,from which 40 plaques were respectively chosen and studied immunohistochemically.Computer aided planimetry was used to measure the positive area of different cells and gene expression.Results The percentages of cells positive for caspase-3,Bax,Bcl-2 in unstable plaques and stable plaques were respectively 27.4%and 15.4%(P<0.05);20.9%and 15.1%(P<0.05);5.9%and 10.3%(P<0.01).Conclusion There are higher apoptosis indexes in unstable plaques and apoptosis promotes the development of unstable plaques.Bax/Bcl-2 is relative to apoptosis in plaques and Bcl-2 plays a role in blocking the development of plaque.

细胞凋亡,是指细胞在一定的生理或病理条件下,遵循自身程序自己结束其生命的程序性死亡.它是有一系列酶参与、由基因控制的一个主动的、高度有序的死亡过程,表现为细胞浆浓缩,染色质固缩,最后形成多个凋亡小体而被吞噬.对生物机体的正常发育及自身稳定具有极其重要的作用.细胞凋亡功能的失控、抑制或增加均会引起机体平衡失调,是多种疾病产牛的重要原因之一.