Alkan Ozlem, Kizilkilic Osman, Yildirim Tulin, Atalay Hakan
Department of Radiology, Baskent University, Faculty of Medicine, Ankara, Turkey.
Eur J Radiol. 2009 Sep;71(3):450-5. doi: 10.1016/j.ejrad.2008.05.006. Epub 2008 Jun 18.
Although it has been demonstrated that there is a high prevalence of extracranial carotid artery stenosis (ECAS) in patients with severe coronary artery disease, intracranial cerebral artery stenosis (ICAS) is rarely mentioned. We evaluated the prevalence of ICAS in patients with ECAS having elective coronary artery bypass grafting (CABG) surgery to determine the relations between ICAS, ECAS and atherosclerotic risk factors.
We retrospectively reviewed the digital subtraction angiography findings of 183 patients with ECAS> or =50% preparing for CABG surgery. The analyses focused on the intracranial or extracranial location and degree of the stenosis. The degree of extracranial stenoses were categorized as normal, <50%, 50-69%, 70-89%, and 90-99% stenosis and occluded. The degree of intracranial stenosis was classified as normal or < or =25%, 25-49%, and > or =50% stenosis and occluded. Traditional atherosclerotic risk factors were recorded.
ECAS<70% in 42 patients and ECAS> or =70% in 141 patients. ICAS was found in 51 patients and ICAS> or =50% in 30 patients. Regarding risk factors, we found hypertension in 135 patients, diabetes mellitus in 91 patients, hyperlipidemia in 84 patients, and smoking in 81 patients. No risk factor was significant predictors of intracranial atherosclerosis. The severity of ICAS was not significantly associated with that of the ECAS.
We found ICAS in 27.8% of the patients with ECAS>50% on digital subtraction angiography preparing for CABG. Therefore a complete evaluation of the neck vessels with magnetic resonance or catheter angiography seems to be indicated as well as intracranial circulation for the risk assessment of CABG.
尽管已证明严重冠状动脉疾病患者颅外颈动脉狭窄（ECAS）的患病率很高，但颅内脑动脉狭窄（ICAS）却很少被提及。我们评估了接受择期冠状动脉搭桥术（CABG）的ECAS患者中ICAS的患病率，以确定ICAS、ECAS与动脉粥样硬化危险因素之间的关系。
我们回顾性分析了183例准备接受CABG手术且ECAS≥50%患者的数字减影血管造影结果。分析重点在于颅内或颅外狭窄的位置和程度。颅外狭窄程度分为正常、<50%、50 - 69%、70 - 89%、90 - 99%狭窄以及闭塞。颅内狭窄程度分为正常或≤25%、25 - 49%、≥50%狭窄以及闭塞。记录传统的动脉粥样硬化危险因素。
42例患者ECAS<70%，141例患者ECAS≥70%。51例患者发现有ICAS，30例患者ICAS≥50%。关于危险因素，我们发现135例患者有高血压，91例患者有糖尿病，84例患者有高脂血症，81例患者有吸烟史。没有危险因素是颅内动脉粥样硬化的显著预测因素。ICAS的严重程度与ECAS的严重程度无显著相关性。
在准备接受CABG手术且数字减影血管造影显示ECAS>50%的患者中，我们发现27.8%存在ICAS。因此，对于CABG风险评估，似乎不仅需要通过磁共振或导管血管造影对颈部血管进行全面评估，还需要对颅内循环进行评估。
