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阻塞性頸動脈病變之血管攝影評估
Angiographic Evaluation of the Occlusive Vascular Diseases in the Neck
摘要
過去兩年中有213例因暫時性腦缺血(transient ischemic attack-TIA)，輕微缺血性腦中風(minor ischemic stroke-MIS)，重度缺血性腦中風(complete ischemic stroke-CIS)患者及58例無腦缺血性中風患者（對照組）曾接受頸總動脈及腦血管攝影(common carotid and cerebral angiography)檢查。分析結果發現50歲以上並無腦缺血症狀之國人，其頸部頸動脈呈現動脈粥瘤斑(atheromatous plaque)性狹窄者佔8.6%；但TIA，MIS及CIS患者則分別高達65%，56%及58.2%，這些頸動脈粥瘤斑性血管狹窄多數未超過30%。頸部頸動脈呈現完全阻塞(complete occlusion)者，在TIA佔13.3%，MIS佔8%，而CIS則高達17.3%，此種血管完全阻塞的患者均具良好的側枝循環(collateral circulation)。頸部頸動脈粥瘤病變有93%發生於總頸動脈與內外頸動脈分又處2公分之內，尤以內頸動脈近端為最多，總頸動脈次之，其次則為外頸動脈近端。本文動脈粥瘤之患者中有30.6%曾接受動脈內膜去除術，我們將於今後三至五年內追踪調查這些曾接受手術及未接受手術的患者，以了解其病情發展暨有無再發以評估此一手術的預防價值。
關鍵字
無資料並列摘要
In the past 2 years, 213 cases of cerebral ischemic strokes were evaluated by bilateral carotid angiography for both intra- and extracranial arterial textures, especially for the athero-matous vascular stenosis. Fift eight non-stroke cases (such as brain tumours and head traumas) were examined as a control group. In this study we found that the incidence of atheromatous stenosis of the neck vessels in non-symptomatic patients above 50 years of age was 8.6%. In the symptomatic patients the incidence were 53.3% in Transient Ischemic Attack (TIA), 50% in Minor Ischemic Stroke (MIS) and 41.8% in Complete Ischemic Stroke (CIS) respectively. In addition, the incidence of atheromatous stenosis of the opposite side (non-symptomatic side) was 33.3% in TIA, 44% in MIS and 32.7% in CIS simultaneously, which were really beyond the author's expectation. In vast majority of the symptomatic cases the degree of arterial occlusion were less than 30%. The incidence of atheromatous stenosis of the external carotid artery was 10% in TIA, 20% in MIS and 1% in CIS. Complete occlusion of the neck vessels in this series was 13.3% in TIA, 8% in MIS and 17.3% in CIS. Thirty cases (30.6%) in this series received 34 endarterectomies, except 1 case developed post-operative stroke, most of the patients were recovered satisfactorily and some of the remainders showed no apparent changes as compared with the pre-operative condition. Both the non-operative and post-operative series shall be followed in the next 3-5 years for comparison of the recurrent rate of TIA and strokes.