Relationship between Microembolous and Artery Stenosis Degree in Symptomatic
Intracranial and Extracranial Artery Stenosis

Abstract

Abstract:

【Abstract】 Objective To study and compare microembolic signal (MES) incidence in different degree artery stenosis in symptomatic intracranial and extracranial artery stenosis. Methods The patients diagnosed symptomatic intracranial or extracranial artery stenosis were recruited while the patients who have tandem stenosis in the intracranial and extracranial artery and potential embolic source were excluded. All the enrolled patients were divided into carotid artery stenosis group or middle cerebral artery stenosis group or vertebral-basilar artery stenosis group. In each group, they were further divided into different groups on the basis of the degree of the stenosed artery: mild stenosis group, middle stenosis group, severe stenosis group and occlusive group. And the frequency of MES was compared among the different groups. Results Two hundred and twenty seven patients were recruited in the study (including 73 symptomatic internal carotid stenosis, 126 symptomatic middle cerebral artery stenosis and 28 symptomatic vertebral-basilar artery stenosis). The MES incidence of the three groups were 34.25% (25/73), 38.89% (49/126) and 39.29% (11/28). There is no difference in MES incidence among the three groups (P >0.05). Further we divided all the symptomatic stenosis arteries into mild, middle, severe stenosis and occlusive group. By comparing the MES incidence, we found that the middle stenosis group and severe stenosis group were higher than the mild stenosis group (P <0.01) and the occlusive group (P <0.01). But there is no difference in the MES incidence between the mild stenosis group and the occlusive group (P >0.05). Conclusion MES is more frequently seen in patients with middle or severe vascular stenosis while the mild and occlusion groups have a low frequency of MES.

Key words: Microembolous; Artery stenosis, Symptomatic; Ischemic stroke

摘要：

【摘要】目的研究颅内外血管不同狭窄程度和闭塞时微栓子的阳性率差异。方法连续选取症状性颅内外血管狭窄并除外存在同侧颅内外血管串联狭窄的患者，按责任血管分为颈内动脉狭窄、大脑中动脉狭窄和椎-基底动脉狭窄3组，按照责任血管的狭窄程度分为轻度、中度、重度狭窄和闭塞组。所有患者行经颅多普勒超声（transcranial Doppler sonography，TCD）检测病变侧微栓子，比较各组间微栓子阳性率的差异。结果研究期间共227例入组，颈内动脉狭窄组73例、大脑中动脉狭窄组126例、椎-基底动脉狭窄组28例，3组的微栓子阳性率分别为34.25%（25/73）、38.89%（49/126）、39.29%（11/28），无显著差异。中度狭窄组及重度狭窄组的微栓子阳性率高于轻度狭窄组（P <0.001）及闭塞组（P <0.001），轻度狭窄组与闭塞组栓子阳性率无显著差异。结论中、重度颅内外血管狭窄者易发生微栓子的脱落，轻度狭窄组与血管闭塞组微栓子阳性率较低。

关键词: 微栓子; 血管狭窄; 症状性; 缺血性卒中

WU Xiu-Juan*, LIU Kang-Ding, YANG Yi,WANG Zheng-Zheng, XING Ying-Qi.. Relationship between Microembolous and Artery Stenosis Degree in Symptomatic
Intracranial and Extracranial Artery Stenosis[J]. Chinese Journal of Stroke, 2014, 9(03): 188-192.

吴秀娟1，刘亢丁2，杨弋2，王峥峥2，邢英琦1. 症状性颅内外血管不同狭窄程度微栓子
阳性率研究[J]. 中国卒中杂志, 2014, 9(03): 188-192.

References

参考文献

1 Ho lms t e d t CA, Tu r a n TN, Ch imowi t z MI .

Atherosclerotic intracranial arterial stenosis:risk

factors, diagnosis, and treatment[J]. Lancet Neurol,

2013, 12:1106-1114.

2 Wh i twor t h JA, Wor ld He a l t h Orga n i z a t ion ,

International Society of Hyper tension Writing

Group. 2003 World Health Organization (WHO)/

International Society of Hypertension (ISH) statement

on management of hypertension[J]. J Hypertens, 2003,

21:1983-1992 .

3 Alberti KG, Zimmet PZ. Definition, diagnosis and

classfication of diabetes mellitus and its complication.

Part 1:diagnosis and classification of diabetes mellitus

provisional report of a WHO consultation[J]. Diabet

Med, 1998, 15:539-553.

4 National Cholesterol Education Program (NCEP)

Expert Panel on Detection, Evaluation, and Treatment

of High Blood Cholesterol in Adults (Adult Treatment

Panel III). Third Report fo the National Cholesterol

Educat ion Prog r am (NCEP) Expe r t Panel on

Detection, Evaluation, and Treatment of High Blood

Cholesterol in Adults (Adult Treatment Panel III) final

report[J]. Circulation, 2002, 106:3143-3421.

5 Wang Y, Cui L, Ji X, et al. The China National Stroke

Registry for patients with acute cerebrovascular

events:design, rationale, and baseline patient

characteristics[J]. Int J Stroke, 2011, 6:355-361.

6 S o r e n s e n AG, Ay H. Tr a n s i e n t i s c h emi c

attack:defination, diagnosis, and risk stratification[J].

Neuroimaging Clin N Am, 2011, 21:303-313.

7 中华医学会. 各类脑血管疾病诊断要点[J]. 中华神经

科杂志, 1996, 29:379-380.

8 华扬. 实用颈动脉超声与颅脑血管超声诊断学[M]. 北

京:科学出版社, 2002:167-176.

9 高山, 黄家星. 经颅多普勒的诊断技术与临床应用[M].

北京:中国协和医科大学出版社, 2004:38-92.

10 Chen J, Wang L, Bai J, et al. The optimal velocity

criterion in the diagnosis of unilateral middle cerebral

artery stenosis by transcranial Doppler[J]. Cell

Biochem Biophys, 2013 Oct 22.[Epub ahead of print]

11 Wong KS, Li H, Chan YL, et al. Use of transcranial

Doppler ultrasound to predict outcome in patients

with intracranial large-artery occlusive disease[J].

Stroke, 2000, 31:2641-2647.

12 Consensus committee of the ninth international

c e r e b r a l h emo d y n ami c s ymp o s i um. Ba s i c

identification criteria of Doppler microembolic

signals[J]. Stroke, 1995, 26:1123.

13 Babikian VL, Hyde C, Pochay V, et al. Clinical

correlates of high-intensity transient signals detected

on transcranial Doppler sonography in patients with

cerebrovascular disease[J]. Stroke, 1994, 25:1570-1573.

14 Babikian VL, Wijman CA, Hyde C, et al. Cerebral

microembolism and early recurrent cerebral or retinal

ischemic events[J]. Stroke, 1997, 28:1314-1318.

15 Orlandi G, Parenti G, Bertolucci A, et al. Silent

cerebral microembolism in asymptomatic and

symptomatic carotid artery stenoses of low and high

degree[J]. Eur Neurol, 1997, 38:39-43.

16 Telman G, Kouperberg E, Hlebtovsky A, et al.

Determinants of micro-embolic signals in patien

with atherosclerotic plaques of the internal carotid

artery[J]. Eur J Vasc Endovasc Surg, 2009, 38:143-147.

17 Eicke BM, von Lorentz J, Paulus W. Embolus

detection in different degrees of carotid disease[J].

Neurol Res, 1995, 17:181-184.

18 Li ZY, Howarth SP, Tang T, et al. Structural analysis

and magnetic resonance imaging predict plaque

vulnerability:a study comparing symptomatic and

asymptomatic individuals[J]. J Vasc Surg, 2007,

45:768-775.

19 Jing LN, Gao PY, Lin Y, et al. Distribution of wall

shear stress in carotid plaques using magnetic

resonance imaging and computational fluid dynamics

analysis:a preliminary study[J]. Chin Med J (Engl),

2011, 124:1465-1469.

20 Sadat U, Teng Z, Young VE, et al. Association

between biomechanical st r uct ural st resses of

atherosclerotic carotid plaques and subsequent

ischaemic cerebrovascular events:A longitudinal in

vivo magnetic resonance imaging-based finite element

study[J]. Eur J Vasc Endovasc Surg, 2010, 40:485-491.

21 Wu XJ, Xing YQ, Wang J, et al. Clinical utilization

of microembolus detection by transcranial Doppler

sonography in int racranial stenosis-occlusive

disease[J]. Chin Med J (Engl), 2013, 126:1355-1359.

22 Wang X, Lin WH, Zhao YD, et al. The effectiveness

of dual antiplatelet treatment in acute ischemic stroke

patients with intracranial arterial stenosis:a subgroup

analysis of CLAIR study[J]. Int J Stroke, 2013, 8:663-668.

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