脑动脉狭窄的分布及影像学评估研究进展

摘要/Abstract

摘要：

我国10%～20%的缺血性卒中患者是由脑动脉狭窄所致，究其病因主要是动脉粥样硬化。我国缺血性卒中患者颅内动脉粥样硬化性狭窄发生率高于颅外动脉。因此，颅内外动脉粥样硬化性狭窄的早期诊断对预防卒中的发生具有重要临床意义。目前，磁共振血管成像（magnetic resonance angiography，MRA）、高分辨率磁共振成像（high-resolution magnetic resonance imaging，HRMRI）、计算机断层扫描血管造影（computed tomography angiography，CTA）、数字减影血管造影（digital subtraction angiography，DSA）等影像学检查已广泛应用于颅内外动脉狭窄的评估。通过血管影像学显示狭窄分布差异，从而探索卒中的发病机制已成为近些年研究的热点，本文就缺血性卒中患者的脑动脉狭窄分布规律及影像学评估的研究进展情况做一综述。

文章导读： 本文就脑动脉狭窄分布的影响因素及影像学评估手段的最新研究进展情况做了综述，从而为卒中
的防治提供理论依据。

关键词: 缺血性卒中; 脑动脉; 狭窄; 分布; 影像学

Abstract:

In China, 10%~20% patients with ischemic stroke are due to cerebral artery stenosis, which is mainly caused by atherosclerosis. Many studies have showed that intracranial artery stenosis is more frequent than extracranial artery stenosis in Chinese patients with ischemic stroke. Therefore, the early diagnosis of ex-intracranial artery stenosis is important to prevent the occurrence of cerebral infarction. Until recently, magnetic resonance angiography (MRA), highresolution magnetic resonance imaging (HRMRI), computed tomography angiography (CTA), digital subtraction angiography (DSA) have been widely applied to assessment of ex-intracranial arterial stenosis. A hot topic in recent years is that by using neuroimaging to explore the etiology and pathogenesis of ischemic stroke according to cerebral artery stenotic distribution. In this article, we aimed to make a review of advance in the assessment of cerebral artery stenotic distribution by neuroimaging.

Key words: Ischemic stroke; Cerebral artery; Stenosis; Distribution; Imaging

周全1，佟旭2，王海英2，李欣3，曹亦宾2. 脑动脉狭窄的分布及影像学评估研究进展[J]. 中国卒中杂志, 2014, 9(06): 534-538.

ZHOU Quan*, TONG Xu, WANG Hai-Ying, LI Xin, CAO Yi-Bin.. Advance in Assessment of Cerebral Artery Stenotic Distribution by Neuroimaging[J]. Chinese Journal of Stroke, 2014, 9(06): 534-538.

参考文献

参考文献

1 Frey JL, Jahnke HK, Bulfinch EW. Difference in

stroke between White, Hispanic, and Native American

patients:the Barrow Neurological Institute stroke

database[J]. Stroke, 1998, 29:29-33.

2 Feigin VL, Lawes CM, Bennett DA, et al. Worldwide

stroke incidence and early case fatality reported in

56 population based studies:a systematic review[J].

Lancet Neurol, 2009, 8:355-369.

3 Turan TN, Makki AA, Tsappidi S, et al. Risk factors

associated with severity and location of intracranial

arterial stenosis[J]. Stroke, 2010, 41:1636-1640.

4 Yang EY, Chambless L, Sharrett AR, et al. Carotid

arterial wall-characteristics are associated with

incident ischemic stroke but not cornoary heart

disease in the Atherosclerosis Risk in Communities

(ARIC) Study[J]. Stroke, 2012, 43:103-108.

5 李兰晴, 钟维章, 陈渊, 等. 急性脑梗死患者脑动脉

狭窄的分布及影响因素[J ]. 实用医学杂志, 2012,

28:1139-1141.

6 曹裕民, 张雄, 万鑫, 等. 性别与颅内动脉粥样硬化性

狭窄关系的研究[J]. 中华老年心脑血管病杂志, 2014,

16:62-65.

7 Wang Y, Zhao X, Liu L, et al. Prevalence and

outcomes of symptomatic intracranial large artery

stenoses and occlusions in China:the Chinese

Intracranial Atherosclerosis (CICAS) Study[J]. Stroke,2014, 45:663-669.

8 Lee TH, Hsu WC, Chen CJ, et al. Etiologic study of

young ischemic stroke in Taiwan[J]. Stroke, 2002,

33:1950-1955.

9 Siddiq F, Chaudhry SA, Vazquez G, et al. Intracranial

stenosis in young patients:unique characteristics and

risk factors[J]. Neuroepidemiology, 2012, 38:148-153.

10 陈波, 郑, 郭舜源. 青年动脉粥样硬化性颅内外血管

狭窄的特征及危险因素分析[J]. 中华全科医学, 2013,

11:1851-1852.

11 Pu Y, Liu L, Wang Y, et al. Geog r aphic and

sex difference in the distribution of intracranial

atherosclerosis in China[J]. Stroke, 2013, 44:2109-

2114.

12 Huang HW, GuO MH, Lin RJ, et al. Prevalence

and risk factors of middle cerebral artery stenosis

in asymptomatic residents in Rongqi Count ry,

Guangdong[J]. Cerebrovasc Dis, 2007, 24:111-115.

13 Xue MZ, Li YJ, Gao XG, et al. Atherosclerotic

stenosis of intracranial and extracranial cerebral

arteries in patients with cerebral infarction and the

correlative factors[J]. Zhong Hua Yi Xue Za Zhi, 2011,

91:762-765.

14 Li D, Wang ML, Li SM, et al, Distribution and risk

factors of steno-occlusive lesions in patients with

ischemic cerebrovascular disease[J]. Zhonghua Yi

Xue Za Zhi, 2008, 88:1158-1162.

15 孙瑄, 陶庆玲, 缪中荣, 等. 缺血性脑血管病患者颅内

外动脉狭窄分布研究[J]. 临床神经外科杂志, 2012,

9:340-342.

16 宋桂芹, 王拥军, 董可辉, 等. 缺血性脑血管病患者脑

动脉狭窄的分布[J]. 中华老年心脑血管病杂志, 2008,

10:680-683.

17 Lau AY, Wong KS, Lev M, e t a l. Bu rden of

int racranial steno-occlusive lesions on initial

computed tomography angiography predicts poor

outcome in patients with acute stroke[J]. Stroke, 2013,

44:1310-1316.

18 高山, 黄家星, 黄一宁, 等. 颅内大动脉狭窄的检查方

法和流行病学调查[J]. 中国医学科学院学报, 2003,

25:96-100.

19 Feldmann E, Wilterdink JL, Kosinski A, et al. The

Stroke Outcomes and Neuroimaging of Intracranial

Atherosclerosis (SONIA) trial[J]. Neurology, 2007,

68:2099-2106.

20 Kim YS, Lim SH, Oh KW, et al. The advantage of

high-resolution MRI in evaluating basilar plaques:A

comparision study with MRA[J]. Atherosclerosis,

2012, 224:411-416.

21 Liu Q, Huang J, Degnan AJ, et al. Comparison of

high-resolution MRI with CT angiography and

digital subtraction angiography for the evaluation of

middle cerebral artery atherosclerotic steno-occlusive

disease[J]. Int J Cardiovasc Imaging, 2013, 29:1491-

1498.

22 Takaya N, Yuan C, Chu B, et al. Presence of

intraplaque hemorrhage stimulates progression of

carotid atherosclerotic plaques:a high-resolution

magnetic resonance imaging study[J]. Circulation,

2005, 111:2768-2765.

23 王金龙, 凌锋, 李慎茂, 等. DSA在急性缺血性脑血

管病介入治疗中的应用[J].介入放射学杂志, 2008,

17:80-84.

24 Gon z á le z RG, Lev MH, Goldma che r GV, e t

a l . Imp r ove d ou t c ome p r e d i c t io n u s i ng CT

angiography in addition to standard ischemic stroke

assessment:results from the STOP Stroke study[J].

PLoS One, 2012, 7:1-6.

25 Nguyen-Huynh MN, Wintermark M, English J, et

al. How accurate is CT angiography in evaluating

intracranial atherosclerotic disease?[J]. Stroke, 2008,

39:1184-1188.

26 Menonn BK, O'Brien B, Bivard A, et al. Assessment

of leptomeningeal collaterals using dynamic CT

angiography in patients with acute ischemic stroke[J].

Cereb Blood Flow Metab, 2013, 33:365-371.

27 Fröl ich AM, Psychogios MN, Klot z E, et al.

Angiographic reconstructions from whole brain

perfusion CT for the detection of large vessel

occlusion in acute stroke[J]. Stroke, 2012, 43:97-102.

28 Frölich AM, Schrader D, Klotz E, et al. 4D CT

angiography more closely def ines int racranial

thrombus burden than single phase CT angiography[J].

AJNR Am J Neuroradiol, 2013, 34:1908-1913.

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