【摘要】 目的 探讨颈动脉粥样硬化(CAS)斑块及血脂、血糖(BG)、纤维蛋白原(Fbg)水平与脑梗死的关系。方法 对2007年11月—2008年12月入院的91例脑梗死患者,应用彩色多普勒检测其颈动脉内中膜厚度(IMT)、斑块数和性状,同时检测血脂、血糖、纤维蛋白原水平,并与正常对照组比较。结果 ①与正常对照组比较,脑梗死组IMT明显增厚、CAS斑块检出率、软斑百分比明显增高(Plt;005)。②血清总胆固醇(TC)、低密度脂蛋白(LDL)、BG及Fbg水平脑梗死组明显高于正常对照组(Plt;005);脑梗死有斑块亚组明显高于无斑块亚组(Plt;005)。③脑梗死组IMT与TC、LDL、BG、Fbg水平(r分别为0.32、0.34、0.30、0.36,Plt;005)。结论 脑梗死患者IMT增厚,CAS斑块及软斑发生率高。BG、TC、LDL及Fbg水平增高是脑梗死及CAS斑块发生的危险因素。
ObjectiveTo observe the effect of interventional thrombolytic therapy for central retinal artery occlusion (CRAO) with ipsilateral internal carotid artery occlusion via supratrochlear artery retrogradely or external carotid artery anterogradely.MethodsNine CRAO patients (9 eyes) were enrolled in this study, including 5 males and 4 females. The mean age was (45.2±18.1) years. The mean onset duration was 24 hours. There were 4 eyes with vision of no light perception, 3 eyes with light perception and 2 eyes with hand movement. Fundus fluorescein angiography (FFA) examination showed that the retinal artery was filled with delayed fluorescence. The peak of fluorescence was seen in the anterior part of the artery, and some of the eyes showed retrograde filling. The arm-retinal circulation time (A-Rct) was ≥35 s in 4 eyes, ≥35 s - ＜25 s in 5 eyes. The filling time of retinal artery and its branches (FT) was ≥15 s in 2 eyes, ≥12 s - ＜15 s in 3 eyes, ≥9 s - ＜12 s in 4 eyes. All the patients received the treatment of interventional thrombolytic therapy via supratrochlear artery retrogradely (8 eyes) or external carotid artery anterogradely (1 eye) according to the indications and contraindications of thrombolytic therapy in acute cerebral infraction patients. Urokinase (0.4 million U in total) was intermittently injected into the arteries. After artery thrombolysis, the changes of digital subtraction angiography (DSA), filling time of retinal artery and its branches on FFA within 24 hours and the visual acuity were observed. According to the A-Rct and FT on FFA, the therapeutic effects on retinal circulation were defined as effective markedly (A-Rct≤15 s, FT≤2 s) , effective (A-Rct was improved but in the range of 16 - 20 s, FT was in 3 - 8 s) and no effect (A-Rct was improved but ≥21 s, FT≥9 s). The related local or systemic complications were recorded.ResultsAfter the injection of urokinase into the catheter, the ophthalmic artery and its branches were increased in 6 eyes (66.7%), and the development of the eye ring was significantly more than that of the eyes before thrombolysis. The circulation time in ophthalmic artery was speeded up for 2 s before thrombolysis in 3 eyes, 3 s in 3 eyes, and 4 s in 2 eyes. Within 24 hours after thrombolysis treatment, the A-Rct was significantly decreased than that of before interventional therapy. The retinal circulation was effective markedly in 4 eyes (44.4%), effective in 4 eyes (44.4%) and no effect in 1 eyes (11.2%) . The vision was improved 3 lines in 4 eyes (44.4%), 2 lines in 3 eyes (33.3%), 1 line in 1 eye (11.2%) and no change in 1 eye (11.2%). There were no abnormal eye movements, vitreous hemorrhage and incision hematoma, intracranial hemorrhage, cerebral embolism, and other local and systemic adverse effectives during the follow-up.ConclusionsThe interventional thrombolytic therapy via supratrochlear artery retrogradely or external carotid artery anterogradely for CRAO with the ipsilateral internal carotid artery occlusion can improve retinal circulation and vision. There are no related local or systemic complications.
This case was an elderly male patient with symptomatic aortic valve calcification and severe aortic valve stenosis. Before the operation, the heart valve team had fully evaluated the patient’s suitability for transcatheter aortic valve replacement and approach. This patient had severe stenosis and plaques in the iliac artery, femoral artery, descending aorta, so the carotid artery approach transcatheter aortic valve replacement was chosen. After the operation, the patient’s symptoms improved significantly. So far, the patient was generally in good condition, without chest tightness, shortness of breath and other symptoms in daily activities. The current clinical application of the transcarotid approach is relatively small, but it is believed that with the publication of more clinical research results, the application of the transcarotid approach in transcatheter aortic valve replacement will become more and more common.
Objective To observe the clinical characteristics and therapeutic effects of carotid artery stenosisrelated ocular ischemic appearance(OIA).Methods The clinical data of 210 patients of carotid artery stenosis (81 of them with OIA) were retrospectively reviewed. They were diagnosed by color doppler image（CDI）or digital subtraction angiography (DSA),and had undergone medicine,carotid artery stenting (CAS)and carotid endarterectomy (CEA). Of 81 patients with OIA,49 patients (60.49%) with OIA only, 32 patients（39.51%）with ocular ischemic disease (OID).24/32 OID patients received ophthalmic treatment such as retinal laser photocoagulation and anti glaucoma therapy (drugs and cyclocryotherapy). Results The ocular manifestations of 81 OIA patients included transient amaurosis in 38 cases (47.14%),flash before the eye in 30 cases (36.67%), periorbital swelling and pain in 28 cases (34.57%), diplopia in 11 cases (13.58%) and vision loss in 9 cases (11.11%). The ocular manifestations of 32 OID patients included ischemic optic neuropathy in 9 cases (28.13%), ocular ischemic syndrome in 6 cases (18.75%), central or branch retinal artery occlusion in 6 cases (18.75%), retinal hemorrhage in 5 patients (15.62%)，extraocular muscle paralysis in 4 patients (12.50%) and neovascular glaucoma in 2 patients (6.25%). The higher the degree of carotid stenosis,the higher incidence of ocular ischemic disease,there was highly positive correlation between each other (R=0.837, P＜0.05).The total effective rate of carotid artery stenting and carotid endarterectomy was significantly higher than drug treatment alone (t=2.73, 3.14; P＜0.01). Conclusion The ocular manifestations of carotid stenosis related ocular ischemic appearance can be transient amaurosis, eyes flashing,eye redness,periorbital pain, diplopia and decreased visual acuity.The ocular manifestations of carotid stenosisrelated ocular ischemic disease can be ischemic optic neuropathy, ocular ischemic symptoms, central or branch retinal artery occlusion and neovascular Carotid artery stenting and carotid endarterectomy are more effective than drug treatment alone for those patients.
Hypertensive retinopathy (HR) often coexist with carotid lesions in hypertensive patients. Carotid lesions are closely associated with cardiovascular and cerebrovascular diseases, as well as end events, offering early important evidence to screening high risk patients. HR has significant value to predict target organ damage (TOD) of hypertension including carotid lesion. In addition, hypertensive retinopathy and carotid lesions-related ischemic ocular diseases will cause serious vision function damage. This article is going to summarize the value and correlation between hypertensive retinopathy and carotid lesions in terms of clinical manifestations, pathological physiological mechanism and target organ damage.
Objective To investigate the experience of selective embolization combined with intraoperative internal carotid artery shunt for surgical treatment of carotid body tumor （CBT）. Methods The data of 21 patients （22 sides） with CBT who underwent surgical resection from January 2002 to July 2012 in our hospital were retrospectively reviewed. The all patients’ conditions were fully assessmented and all patients were performed the carotid arteriography and superselective embolization treatment for the blood supply of tumor by with microcatheter on 2-3 days before operation，and then intraoperative internal carotid artery shunt and resection of carotid body tumors were performed. Results Surgical procedures were successfully performeded in all 21 patients （22 sides）. Among them， 16 patients （17 sides） were taken carotid body tumor resected， 5 patients were taken carotid body tumor resected and internal carotid artery reconstruction （autogenous long saphenous vein were used in 3 patients， vascular prosthesis were used in 2 patients）. The postoperative complications were found in 5 patients after anesthesia recovery， which included crooked tongue in 3 cases and facial numbness in 2 cases， and they were cured in 3 months. There were no cerebral infarction， hemiplegia， and death cases. All 21 patients were followed-up for a period from 2 months to 9 years（average 57 months）， there was no tumor recurred. Conclusions Surgical resection is the first choice for treatment of carotid body tumor. The application of selective embolization and intraoperative internal carotid artery shunt for surgical treatment of carotid body tumor in complicated Shamblin Ⅲ stage is safe and effective.
目的 探讨阿托伐他汀钙对颈动脉粥样硬化患者血管内皮的保护作用。 方法 选取2010年10月－2011年8月颈动脉粥样硬化患者80例，随机分为治疗组和对照组。对照组给予阿司匹林肠溶片0.1 g，早饭后口服1次；治疗组在此基础上给予阿托伐他汀钙20 mg，每晚口服1次，10个月为1个疗程。分别在治疗前后进行颈动脉彩色多普勒超声检测颈动脉中膜厚度及颈动脉粥样硬化斑块面积，测定甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、一氧化氮（NO）、血管内皮素-1（ET-1）水平。两组患者在1个疗程治疗结束后停药12周，测定TG、TCH、LDL-C、HDL-C、NO、ET-1水平。 结果 与治疗前比较，治疗组患者的TG、TC、LDL-C、ET-1水平显著降低，HDL-C、NO水平显著升高（P＜0.01）。颈动脉中膜厚度和颈动脉粥样硬化斑块面积明显变小（P＜0.05）。对照组无明显变化。治疗组停药12周后与停药时比较，TG、TC、LDL-C、ET-1水平显著升高，HDL-C、NO水平明显降低（P ＜0.05）。对照组无明显变化。 结论 阿托伐他汀钙能显著改善颈动脉粥样硬化斑块患者的血管内皮功能、血脂水平，稳定颈动脉粥样硬化斑块，促进斑块逆转，且需要长期坚持服用。