Srinivasan Krishnan, Ravikumar Srinivasan, Chandra Sadanandavalli Retnaswami, Ganapathy Selva, Ravi G S
Department of Neurology Madurai Medical College, Apollo Hospitals Madurai, Madurai, Tamil Nadu, India.
Department of Neurocritcal Care, Sri Ramachandra Medical Centre, Chennai, Tamil Nadu, India.
J Neurosci Rural Pract. 2017 Jul-Sep;8(3):352-356. doi: 10.4103/jnrp.jnrp_31_17.
Cerebrovascular accidents constitute the most common cause of disability all over the world. In India prevalence rate is 545 per 100000 and mortality rate is around 7.5 per thousand. Therefore the authors undertook a study on patients who underwent coronary artery bypass surgery (CABG). They were investigated for clinical and/or radiological evidence of cerebrovascular disease (CVD) with the aim to decide on early neurological intervention.
210 patients who had undergone CABG were evaluated with neck vessel Doppler using high resolution duplex scanner system and computed tomography (CT) scan as well as MR angiogram (MRA) in addition to assessment of co morbid risk factors.
91% of patients who had undergone CABG had radiological evidence of CVD. The most common risk associated with CAD and CVD was Hypertension (HT), DM, dyslipidemia and combined HT and DM in that order. Neck vessels were normal in 59%. Significant disease was found in only 7.2%. Internal carotids were abnormal in 82%. Infarcts were seen in 82.1%.
This study reveals patients with CAD have a high degree of asymptomatic CVD. It is mostly due to small vessel disease including internal carotids but not so much with large vessels. Therefore, patients with CAD carry a high risk of vascular cognitive dysfunction. This can be reduced by effective management of the systemic risk factors. Screening for large vessel disease which is commonly done is likely to give a false sense of security.
As against western population Indians seem to have small and medium sized vessels disease in the setting of CAD.
脑血管意外是全球致残的最常见原因。在印度，患病率为每10万人中有545例，死亡率约为千分之7.5。因此，作者对接受冠状动脉旁路移植术（CABG）的患者进行了一项研究。他们接受了脑血管疾病（CVD）的临床和/或放射学证据调查，目的是决定早期神经干预措施。
对210例接受CABG的患者进行评估，除了评估合并症风险因素外，还使用高分辨率双功扫描仪系统进行颈部血管多普勒检查、计算机断层扫描（CT）以及磁共振血管造影（MRA）。
91%接受CABG的患者有CVD的放射学证据。与冠心病和CVD相关的最常见风险依次为高血压（HT）、糖尿病、血脂异常以及高血压和糖尿病合并症。59%的患者颈部血管正常。仅7.2%发现有严重疾病。82%的患者颈内动脉异常。82.1%的患者有梗死灶。
本研究表明，冠心病患者存在高度无症状性CVD。这主要是由于包括颈内动脉在内的小血管疾病，而非大血管疾病。因此，冠心病患者存在血管性认知功能障碍的高风险。通过有效管理全身风险因素可降低这种风险。通常进行的大血管疾病筛查可能会给人一种虚假的安全感。
与西方人群不同，印度人在冠心病背景下似乎存在中小血管疾病。
