颈部血管超声课件.pptVIP

AS的表现形式有两种：稳定斑块和易损斑块。 易损斑块由于纤维帽很薄，而脂质核心大，容易破裂形成血栓。血栓的形成将导致之后的栓子脱落堵塞血管，或原位血栓堵塞血管的过程，从而发生卒中。 可以说动脉粥样硬化斑块的易损性是卒中发生和再发的关健因素。 因此要管理好AS，识别和治疗不稳定斑块是其关键的环节。 下面我将以典型病例进行说明。 Interrelation between plaque surface morphology and degree of stenosis on carotid angiograms and the risk of ischemic stroke in patients with symptomatic carotid stenosis. Stroke，2000.作者？ * 血管超声检查显示左侧斑块以低回声为主，质地欠均，是易损斑块，并导致管径狭窄。而右侧则是中高回声、质地均匀的稳定斑块。 通过高分辨MRI进一步对左侧颈内动脉起始部的斑块进行分析显示斑块质地欠均，同时伴有钙化（黑色）少量出血（稍亮区域），是易损斑块。 左图示：大量脂质成分、无菌性坏死组织和多发钙化斑 右图示：大量炎性细胞浸润 下面我们将通过一个病例对此问题展开讨论。 由于时间有限，本次只针对“此类患者如何选择合适的降压药”问题进行讨论。 介绍病例的要点：老年男患，长期高血压，控制不理想。近一月在血压增高后自服心痛定后曾有短暂肢体乏力症状，但为重视。入院前BP220/110mmHg,静脉使用降压药降至140/90mmHg后出现肢体瘫痪。B超、DSA显示双颈内动脉中-重度狭窄。 双颈内动脉中-重度狭窄 ABSTRACT Background The combined thickness of the intima and media of the carotid artery is associated with the prevalence of cardiovascular disease. We studied the associations between the thickness of the carotidartery intima and media and the incidence of new myocardial infarction or stroke in persons without clinical cardiovascular disease. Methods Noninvasive measurements of the intima and media of the common and internal carotid artery were made with high-resolution ultrasonography in 5858 subjects 65 years of age or older. Cardiovascular events (new myocardial infarction or stroke) served as outcome variables in subjects without clinical cardiovascular disease (4476 subjects) over a median follow-up period of 6.2 years. Results The incidence of cardiovascular events correlated with measurements of carotid-artery intima–media thickness. The relative risk of myocardial infarction or stroke increased with intima–media thickness (P0.001). The relative risk of myocardial infarction or stroke (adjusted for age and sex) for the quintile with the highest thickness as compared with the lowest quintile was 3.87 (95 percent confidence interval, 2.72 to 5.51). The association between cardiovascular events and intima–media thickness remained significant after