The brain blocks the diagnosis of patient's neck atherosclerosis and treats _'s treatment

The brain blocks the diagnosis of patient's neck atherosclerosis and treats _'s treatment
Tang XiaoChun Zhang RenKun 2005-12-13 13:03:46 China's modern clinical practice magazine Number 1 of Vol. 1 of August of 2004
[Atherosclerosis of neck of summary ] is the important dangerous factor that the brain blocks up. It contributes to reducing the incidence which is short of blood apoplexy to intervene in early days, lighten disease. The article has summarized the diagnosis about atherosclerosis of neck and measure which treats the respect in recent years.
Keyword Atherosclerosis of neck Diagnosis Treat

Atherosclerosis of neck is a common cause of disease of the ischemic apoplexy. In the western countries, because the ischemic apoplexy that neck atherosclerosis causes accounts for 19%- 35%[1],Still lack the large-scale epidemiology investigation result at home. A kind of plaque of porridge of arterial carotis causes the artery to be in charge of narrowly, cause blood flow volume to reduce, or loss and organize resulting in carrying the artery to stop up far after breaking by oneself. Atherosclerosis of neck causes narrow gt of arterial carotis; 70% the intersection of patient and year apoplexy their rate can so as to up to 13%, the person who doesn't have symptom is 1%- 2%, relate to a kind of spot piece stability of porridge of narrow place. So neck atherosclerosis has or not, causes narrow intensity, porridge a kind of shape, embolus of the plaque of arterial carotis to be easy to loss etc., of great importance in the morbidity of blocking up on the brain. Treat the intersection of neck and atherosclerosis, block up and lower to disable rate, case fatality rate, have important meanings apoplexy by brain preventing from actively.
At present, the diagnosis and treating, already making very great progress of atherosclerosis of neck. Ultrasonic inspection, mathematics reduce the shadow angiography (DSA) , magnetic resonance blood vessel shadow (MRA) , spiral CT angiography (CTA) Can judge the position, intensity and situation of enclosing spot piece of the wall of atherosclerosis of neck accurately, membrane shaping skill, narrow curative effect of arterial carotis of obvious improvement of application of shaping skill and new medicine of blood vessel in arterial carotis, have reduced complication.
Diagnosis of the 1st neck atherosclerosis
1.1 The supersound is checked and used for finding the ultrasonic instrument of atherosclerosis of neck has formations of image of Ultrasonography B of high-resolution at present, the formation of image of colored Doppler's blood flow, Doppler's formation of image of power, mix the formation of image and formation of image of colored Doppler's blood flow of four-dimension.
1.1.1 The formation of image of Ultrasonography B of high-resolution though Doppler's supersound can be increased widely according to the frequency spectrum that the blood flow unusually displays, measure a kind of plaque narrow lt of porridge of smaller artery; 40%) ,But frequency spectrum it increases wide reasons to be numerous, sometimes difficult to explain, very apt to take place confusion. So, still need high-resolution Ultrasonography B to measure atherosclerosis and comment on the morphological characteristic of the spot piece.
1.1.2 Formation of image of colored Doppler's blood flow (color Doppler flow imaging, CDFI) CDFI whether a combine scanning way together gray the intersection of steps and picture and two-dimentional the intersection of Doppler and signal. Move Doppler frequently to encode color, red, blue represents a blood flow direction respectively, the degree of saturation of color is used for showing the level moved frequently, even vortex can use the color code, thus set off in the blood vessel very obviously. So, CDFI can obviously improve surface of a kind of plaque of porridge of artery and display ability of the structure, especially reflect very weak the intersection of artery and the intersection of porridge and kinds of plaque to supersound, because simple Ultrasonography B very difficult to make their with in charge of, distinguish by.
1.1.3 Doppler's formation of image of power (power Doppler imaging) The power Doppler becomes it is one kind that reveals Doppler's technology of signal amplitude, height and reflection supersound of its steps of color form the quantity of erythrocyte that Doppler moves frequently and is closely related with. In measuring the blood flow, Doppler's formation of image of power is obviously more sensitive than CDFI [2 ] ,Because: ( 1) Can be obviously improved and gained when the background noise is the same; ( 2) More dynamic ranges of signal are used for improving sensitiveness; ( 3) Compared with CDFI, this technology is less likely to rely on receiving one sound of angles, are favorable to the vascular display crookedly; ( 4) Because the signal intensity has something to do with Doppler's signal amplitude, will not produce and mix pile (aliasing) ,Have improved the display to the pathologic properties of blood vessel wall of vortex area; ( 5) There is very strong display ability on blood flow of low velocity of flow.
1.1.4 Mix the formation of image (compounded imaging) Mix in real time as if strengthen ultrasonic picture and the intersection of artery and the intersection of spot and the intersection of piece and new technology that characteristic reveal, different with the rectangular supersound bunch of conventionally ultrasonic technical application, utilize leaving axial scattering ultrasonic imaging, hardwood of picture count and angle that supersound scatter depend on characteristic of popping one's head, the intersection of hardwood and picture that different angle obtain contain independence, random ultrasonic spot, through the superposing and dispelling these spots of hardwood picture, thus raise and organize the resolution ratio. Compared with formation of image of Ultrasonography B of high-resolution, mixing the formation of image obviously inhibits the shade of border, have raised and compared with the resolution ratio, has strengthened the morphological characteristic of the superficial structure of a kind of plaque of porridge of artery, contribute to the appraisal, determination [2 ] of piece position of spot and structural characteristic.
1.1.5 Formation of image of colored Doppler's blood flow of four-dimension (four-dimentional color Doppler flow imaging, 4D-CDFI) 4D-CDFI performance is strong, not only the multidimension that can be used in the blood vessel wall and cut the stress is analyzed, but also the quantification used for blood flow, and mathematics of carrying on the spot piece unstability of arterial carotis the different fields with the quantitative blood flow data is studied,etc.. After the volume background of the colored blood flow data of the four-dimension is presumed, can appraise the overall picture [3 ] of the asymmetrical blood flow correctly, especially in the internal capsule. The average blood flow distribution map of the three-dimension of twinkling of an eye that quantitative 4D-CDFI offers, can be further used in the reconstruction of the four-dimensional artery wall shear rate. This is very useful to mutual dynamic function while expounding composition and some blood dynamics of artery porridge geometirc shape, spot piece of a kind of plaque change, help the sports [4 ] out of shape of spot piece in close relations happens in research, apoplexy, TIA.
1.2 Artery radiography (DSA) DSA can reveal the blood vessel in the shanks and craniums of arterial carotis and vertebra basal arterial system. It is in its advantage space high in resolution ratio,can detection artery narrow intensity and ranges true. Narrow sections of the intersection of artery and the intersection of wall and abnormality brief on spot the intersection of piece and surface to have ulcer that takes shape. DSA can reveal narrow blood flow state and collateral circulation situation that carry far, blood dynamics which observes different time phases changes, it is a gold standard of diagnosing cerebrovascular diseases. Though DSA achieves and has radiography pharmaceutical needed, still employ on clinic extensively.
1.3 Magnetic resonance angiography (MRA) MRA has no achieving technology of formation of image of blood vessel, utilize the flowing on the empty effect of MR to make the blood vessel form images. Use three-dimensional the intersection of time and transition MRA ' 3D-TOF-MRA) Can often reveal shank artery, cranium bottom Willis ring and main artery and backbone branch. MRA can be detected and 4.8% outside the cranium, the incidence of apoplexy is 4.4% in postoperative month, mortality is 1.4%. In these patients, there are 49% as the elderly over 70, and a lot of people have taboo card [7 ] of CEA, this verify the treatment to treat one the intersection of application and the intersection of range and wide, the intersection of security and high clinical the intersection of curative effect and definite treatment means [8 ], neck of arteriosclerosis. Atherosclerosis of neck one is kind to take place to the initial department of artery in common carotid artery branching department and cranium in the position. At present, the card is that the clinic of the arterial carotis PTA and SP adapts to: ( 1) There are companions such as obvious coronary heart disease, congestive heart declining, chronic obstructive lung disease,etc. persons who have illness coming on; ( 2) Disease patient of arterial system of high shank neck; ( 3) Continue the hair on the arterial carotis narrow or acute arterial carotis intermediate layer person of the shank radiotherapy; ( 4) The hair is narrower that CEA carries on; ( 5) Person who stops up arterial carotis of offside. The operation methods and apparatus conditions of PTA and SP are expected relatively much, should go on in one pair of balls is in charge of the digital subtraction (DSa) system of the image and conduit of the blood flow dynamics checkout equipmenting, should have lasted aspirin patient skill ago,oh chlorine rolls of pyridine or last gram to set up by medicines special. Competent the intersection of neck and arteriectasis or support at the skill, present, pass sex heart rate slow down and blood pressure drop because of pressing onto the hard artery sinus often in the skill, at this moment can by atropine, among come hydroxy amine or Nitroglycerin it last heart rate or blood pressure. The operation can lead and lead the tube to enter every relevant brain blood vessel outside the cranium by the belly artery by one, guide steel wire stride the intersection of artery and the intersection of pathological change and one through it, then lead the silk, put one sacculus in the artery focus, expand the sacculus subsequently, then fetch

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