Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Ann Transl Med. 2014 Aug;2(8):78. doi: 10.3978/j.issn.2305-5839.2014.08.10.
Large arteries are the upstream vessels of cerebral small vessels, through which blood flow is transported. Since structurally and functionally connected, large arteries and cerebral small vessels are physiologically correlated. However, large vessel diseases and small vessel diseases are investigated separately in old era. More and more evidence suggested they are inter-mingled and should be considered together. When a deep brain lacunar infarct occurs, it is of necessity to perform high-resolution magnetic resonance imaging to screen intracranial large artery atherosclerosis, which requires more intensified treatment. It may be the appropriate strategy to keep longitudinal monitoring of the trend of large artery stiffness and give intervention such as aggressive blood pressure control to prevent cerebral white matter lesions (WMLs) occurrence or progression. More data from cohort studies are required, especially the biomarkers of "diseased" artery stiffness. In the future, when randomized clinical trials are performed, the end points should take both large artery and small vessel damages into consideration. The two diseases are in the same "boat", i.e., the pan-vessel diseases. In order to save one, we have to save both.
大动脉是脑小血管的上游血管，血液通过大动脉输送至脑小血管。由于在结构和功能上相互连接，大动脉和脑小血管在生理学上是相关的。然而，在过去的时代，大血管疾病和小血管疾病是分开研究的。越来越多的证据表明，它们是相互交织的，应该一起考虑。当发生深部脑腔隙梗死时，有必要进行高分辨率磁共振成像以筛查颅内大动脉粥样硬化，这需要更强化的治疗。持续监测大动脉僵硬趋势并给予积极的血压控制等干预措施以预防脑白质病变（WML）的发生或进展可能是一种恰当的策略。需要更多来自队列研究的数据，特别是“病变”动脉僵硬的生物标志物。将来进行随机临床试验时，终点应同时考虑大血管和小血管损伤。这两种疾病在同一“船上”，即全血管疾病。为了拯救一方，我们必须拯救双方。
