发现脑动脉狭窄了应该怎 么办？-20120813 课件.pptVIP

颅外颈动脉狭窄 CEACAS +积极药物治疗 症状性 颅内动脉狭窄 积极药物治疗： 他汀、抗血小板、降压 支架可能也有效 但首选药物治疗一定是对的 * Lars Marquardt. Low Risk of Ipsilateral Stroke in Patients With Asymptomatic Carotid Stenosis on Best Medical Treatment: A Prospective, Population-Based Study. Stroke 2010;41;e11-e17; * 同侧TIA风险1.78%，没有一例严重卒中事件发生 Lars Marquardt, Olivia C. Geraghty, Ziyah Mehta and Peter M. Rothwell Low Risk of Ipsilateral Stroke in Patients With Asymptomatic Carotid Stenosis on Best Medical Treatment: A Prospective, Population-Based Study Stroke 2010;41;e11-e17; 对侧有症状的病人 * 精确机制不清楚，推测： 因为氧不能转运只能通过被动弥散， 但血流下降时，组织氧张力并不低，可能 由于血流和组织之间氧的持续流动所致。 The compensatory reflex to reduced blood flow is an increase in tissue oxygen extraction [20,21]. For a given tissue metabolic rate for oxygen consumption, a reduction in the delivery of oxygen (cerebral blood flow) requires an increase in the amount of oxygen extracted by the blood (oxygen extraction fraction [OEF]) [22]. Normal OEF is 30% to 40%, and can increase instantaneously to up to 80%. The precise mechanism by which this increase occurs is not clear. Oxygen is not transported, and reaches the brain tissue by passive diffusion. Tissue oxygen tensions are not reduced when flow falls. It is likely that OEF increases because of a constant flux of oxygen between the tissue and the blood. When flow falls, there is a relative increase in the amount of oxygen used by the brain [23].精确机制不清楚，推测： 因为氧不能转运只能通过被动弥散， 但血流下降时，组织氧张力并不低，可能 由于血流和组织之间氧的持续流动所致。 * Caplan LR and Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol,1998, 55: 1475–1482 * Arch Neurol. 2009 Sep;66(9):1091-6. Strokes after cardiac surgery and relationship to carotid stenosis. Li Y, Walicki D, Mathiesen C, Jenny D, Li Q, Isayev Y, Reed JF 3rd, Castaldo JE. Abstract OBJECTIVE: To critically examine the role of significant carotid stenosis in the pathogenesis of postoperative stroke following cardiac operations. DESIGN