TCD发泡试验联合CTA筛查青年缺血性脑卒中病因的应用研究
摘要
目的探讨经颅多普勒超声(TCD)发泡试验联合头颈部CT血管成像(CTA)在青年缺血性卒中危险因素筛查中的应用研究。方法收集我院2014年—2016年收治的青年急性缺血性脑卒中病人100例,分析其TCD发泡试验、头颈部CTA结果与可能的危险因素或病因。结果 TCD发泡试验结果显示:阳性14例(14.0%),其中Ⅳ级9例(64.3%),Ⅲ级3例(21.4%),Ⅱ级2例(14.3%)。阴性86例(86.0%),经食管超声心动证实:15例(15.0%)存在卵圆孔未闭(PFO),符合率93.3%。头颈部CTA发现:颈动脉或颅内动脉狭窄或闭塞57例(57.0%),其中烟雾病9例、大动脉炎8例、动脉粥样硬化斑块8例、卵圆孔未闭5例、高血压6例、糖尿病4例、颈动脉夹层2例、颅内动脉瘤2例、海绵状血管瘤1例、室间隔缺损1例、高尿酸血症1例、房性前收缩并室性期前收缩1例,心房纤颤1例、卵巢过度刺激综合征1例、不明原因7例。CTA无明显异常43例(43/57)。所有病人均行经皮股动脉穿刺全脑血管造影术证实,与上述结果吻合。结论 TCD发泡试验筛选PFO敏感性及特异性高,头颈部CTA定位准确、特异性高,二者联合对青年缺血性脑卒中病人危险因素或病因筛查有价值。
引文
[1] 中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[2] JAUSS M,ZANETTE E.Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler sonography [J].Cerebrovascular Diseases(Basel,Switzerland),2000,10(6):490-496.
[3] GONZáLEZ-GóMEZ F J,PéREZ-TORRE P,DEFELIPE A,et al.Stroke in young adults:incidence rate,risk factors,treatment and prognosis[J].Rev Clin Esp,2016,216(7):345-351.
[4] AIQNER A,GRITTNER U,ROLFS A,et al.Contribution of established stroke risk factors to the burden of stroke in young adults[J].Stroke,2017,48(7):1744-1751.
[5] ARBOIX A,MASSONS J,GARCíA-EROLES L,et al.Stroke in young adults:incidence and clinical picture in 280 patients according to their aetiological subtype[J].Med Clin(Barc),2016,146(5):207-211.
[6] 郑小军,刘娟肖,肖飞,等.青年缺血性脑卒中的危险因素及病因TOAST分型研究[J].中国实用神经疾病杂志,2015,18(21):70.
[7] 姚婧皤,张玉梅,王拥军,等.卵圆孔未闭与隐源性卒中的关系探讨[J].中国医刊,2014,49(10):52-55.
[8] KHAN R,CHAN A K,MONDAL T K,et al.Patent foramen ovale and stroke in childhood:a systematic review of the literature[J].Eur J Paediatr Neurol,2016,20(4):500-511.
[9] SUN Y P,HOMMA S.Patent foramen ovale and stroke[J].Circ J,2016,80(8):1665-1673.
[10] HOMMA S,MESSéS R,RUNDEK T,et al.Patent foramen ovale[J].Nat Rev Dis Primers,2016(2):15086.
[11] MONIKA K,MARIA O,TADEUSZ P,et al.Transcranial doppler ultrasonography should it be the first choice for persistent foramen ovale screening?[J].Cardiovascular Ultrasound,2014,12(1):16.
[12] KATSANOS A H,PATSOURAS D,TSIVGOULIS G,et al.The value of transesophageal echocardiography in the investigation and management of cryptogenic cerebral ischemia:a single-center experience[J].Neurol Sci,2016,37(4):629-632.
[13] CHELI M,CANEPA M,BRUNELLI C,et al.Recurrent and residual shunts after patent foramen ovale closure:results from a long-term transcranial Doppler study[J].J Interv Cardiol,2015,28(6):600-608.
[14] 唐舒锦,范玉华,陈红兵,等.伴右向左分流的隐源性缺血性卒中的临床和影像学特征[J].中国神经精神疾病杂志,2016,42(5):267-271.
[15] THOMPSON A J,HAGLER D J,TAGGART N W.Transseptal puncture to facilitate device closure of "long-tunnel" patent foramen ovale[J].Catheter Cardiovasc Interv,2015,85(6):1053-1057.
[16] PEZZINI A,GRASSI M,LODIGIANI C,et al.Propensity score-based analysis of percutaneous closure versus medical therapy in patients with cryptogenic stroke and patent foramen ovale:the IPSYS Registry (Italian Project on Stroke in Young Adults)[J].Circ Cardiovasc Interv,2016,9(9):e003470.
[17] JANSEN I G,BERKHEMER O A,YOO A J,et al.Comparison of CTA- and DSA-based collateral flow assessment in patients with anterior circulation stroke[J].AJNR Am J Neuroradiol,2016,14:4878.
[18] SALLUSTIO F,MOTTA C,PIZZUTO S,et al.CT angiography-based collateral flow and time to reperfusion are strong predictors of outcome in endovascular treatment of patients with stroke[J].Journal of Neurointerventional Surgery,2016,9(10):940-943.
[19] ESWARADASS P,APPIREDDY R,EVANS J,et al.Imaging in acute stroke[J].Expert Rev Cardiovasc Ther,2016,14(8):963-975.
[20] SUNDARAM S,KANNOTH S,THOMAS B,et al.Collateral assessment by CT angiography as a predictor of outcome in symptomatic cervical internal carotid artery occlusion[J].AJNR Am J Neuroradiol,2016,38(1):52-57.
[21] BAXA J,ROHAN V,TUPY R,et al.Determination of the middle cerebral artery occlusion length in acute stroke:contribution of 4D CT angiography and importance for thrombolytic efficacy prediction[J].Clin Neuroradiol,2015,25(3):257-265.
[2] JAUSS M,ZANETTE E.Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler sonography [J].Cerebrovascular Diseases(Basel,Switzerland),2000,10(6):490-496.
[3] GONZáLEZ-GóMEZ F J,PéREZ-TORRE P,DEFELIPE A,et al.Stroke in young adults:incidence rate,risk factors,treatment and prognosis[J].Rev Clin Esp,2016,216(7):345-351.
[4] AIQNER A,GRITTNER U,ROLFS A,et al.Contribution of established stroke risk factors to the burden of stroke in young adults[J].Stroke,2017,48(7):1744-1751.
[5] ARBOIX A,MASSONS J,GARCíA-EROLES L,et al.Stroke in young adults:incidence and clinical picture in 280 patients according to their aetiological subtype[J].Med Clin(Barc),2016,146(5):207-211.
[6] 郑小军,刘娟肖,肖飞,等.青年缺血性脑卒中的危险因素及病因TOAST分型研究[J].中国实用神经疾病杂志,2015,18(21):70.
[7] 姚婧皤,张玉梅,王拥军,等.卵圆孔未闭与隐源性卒中的关系探讨[J].中国医刊,2014,49(10):52-55.
[8] KHAN R,CHAN A K,MONDAL T K,et al.Patent foramen ovale and stroke in childhood:a systematic review of the literature[J].Eur J Paediatr Neurol,2016,20(4):500-511.
[9] SUN Y P,HOMMA S.Patent foramen ovale and stroke[J].Circ J,2016,80(8):1665-1673.
[10] HOMMA S,MESSéS R,RUNDEK T,et al.Patent foramen ovale[J].Nat Rev Dis Primers,2016(2):15086.
[11] MONIKA K,MARIA O,TADEUSZ P,et al.Transcranial doppler ultrasonography should it be the first choice for persistent foramen ovale screening?[J].Cardiovascular Ultrasound,2014,12(1):16.
[12] KATSANOS A H,PATSOURAS D,TSIVGOULIS G,et al.The value of transesophageal echocardiography in the investigation and management of cryptogenic cerebral ischemia:a single-center experience[J].Neurol Sci,2016,37(4):629-632.
[13] CHELI M,CANEPA M,BRUNELLI C,et al.Recurrent and residual shunts after patent foramen ovale closure:results from a long-term transcranial Doppler study[J].J Interv Cardiol,2015,28(6):600-608.
[14] 唐舒锦,范玉华,陈红兵,等.伴右向左分流的隐源性缺血性卒中的临床和影像学特征[J].中国神经精神疾病杂志,2016,42(5):267-271.
[15] THOMPSON A J,HAGLER D J,TAGGART N W.Transseptal puncture to facilitate device closure of "long-tunnel" patent foramen ovale[J].Catheter Cardiovasc Interv,2015,85(6):1053-1057.
[16] PEZZINI A,GRASSI M,LODIGIANI C,et al.Propensity score-based analysis of percutaneous closure versus medical therapy in patients with cryptogenic stroke and patent foramen ovale:the IPSYS Registry (Italian Project on Stroke in Young Adults)[J].Circ Cardiovasc Interv,2016,9(9):e003470.
[17] JANSEN I G,BERKHEMER O A,YOO A J,et al.Comparison of CTA- and DSA-based collateral flow assessment in patients with anterior circulation stroke[J].AJNR Am J Neuroradiol,2016,14:4878.
[18] SALLUSTIO F,MOTTA C,PIZZUTO S,et al.CT angiography-based collateral flow and time to reperfusion are strong predictors of outcome in endovascular treatment of patients with stroke[J].Journal of Neurointerventional Surgery,2016,9(10):940-943.
[19] ESWARADASS P,APPIREDDY R,EVANS J,et al.Imaging in acute stroke[J].Expert Rev Cardiovasc Ther,2016,14(8):963-975.
[20] SUNDARAM S,KANNOTH S,THOMAS B,et al.Collateral assessment by CT angiography as a predictor of outcome in symptomatic cervical internal carotid artery occlusion[J].AJNR Am J Neuroradiol,2016,38(1):52-57.
[21] BAXA J,ROHAN V,TUPY R,et al.Determination of the middle cerebral artery occlusion length in acute stroke:contribution of 4D CT angiography and importance for thrombolytic efficacy prediction[J].Clin Neuroradiol,2015,25(3):257-265.