University of Wisconsin School of Medicine and Public Health, Department of Neurological Surgery, Madison, Wisconsin 53792, USA.
Neurosurgery. 2010 Aug;67(2):484-93; discussion 493-4. doi: 10.1227/01.NEU.0000371730.11404.36.
This review encourages the reader to consider cerebral vascular disease beyond the traditional clinical end points of major motor and speech strokes and to consider the possible impact of embolic cerebral vascular disease on vascular cognitive decline. This article examines the issue of "silent" strokes in the relationship between the structural stability of atherosclerotic carotid plaque and the development of nonmotor symptomatology, including cognitive decline. It addresses the question of the role of carotid emboli in silent stroke and their cognitive sequelae. In a study of endarterectomy patients, we relate plaque elasticity and its development of mechanical strain features and thinning of stabilizing fibrous cap at the point of these mechanical strain features. The possibility that microemboli from such mechanically unstable carotid plaques could contribute to silent strokes led to a study of cognitive function in such patients. A linear relationship between the process of mechanically unstable areas of carotid plaques and cognitive decline suggests a contributory role for such a process in silent strokes.
这篇综述鼓励读者不仅要考虑到主要的运动和言语中风等传统临床终点，还要考虑到栓塞性脑血管疾病对血管性认知衰退的可能影响。本文探讨了在动脉粥样硬化颈动脉斑块的结构稳定性与非运动症状（包括认知能力下降）发展之间“沉默”中风的问题。它探讨了颈动脉栓子在沉默性中风及其认知后果中的作用。在一项颈动脉内膜切除术患者的研究中，我们将斑块的弹性与其机械应变特征的发展以及稳定纤维帽在这些机械应变特征处变薄联系起来。来自这种机械不稳定颈动脉斑块的微栓子可能导致沉默性中风的可能性导致了对这些患者认知功能的研究。颈动脉斑块机械不稳定区域的过程与认知能力下降之间的线性关系表明，这种过程可能在沉默性中风中起作用。
