Weinberger J, Ramos L, Ambrose J A, Fuster V
Department of Neurology, Mount Sinai School of Medicine, New York, New York 10029.
J Am Coll Cardiol. 1988 Dec;12(6):1515-21. doi: 10.1016/s0735-1097(88)80019-6.
Occurrence of new symptoms of focal cerebrovascular disease, including completed cerebral infarction, transient cerebral ischemic attack and amaurosis fugax, was correlated with changes in size and morphology of atherosclerotic plaques at the carotid artery bifurcation visualized by real time B-mode ultrasonography. Bilateral serial images of 246 plaques in 123 patients were made in a time interval of 9 to 35 months between initial and follow-up studies. There was a significantly higher incidence of symptoms ipsilateral to plaques that grew [30 (25%) of 121] than of symptoms ipsilateral to plaques that diminished or remained unchanged [8 (8%) of 98] (p less than 0.001). Plaques that became hemodynamically obstructive by causing disruption of laminar flow or reduction of distal perfusion pressure at the ophthalmic artery were associated with a higher frequency of symptoms [12 (40%) of 30] than were nonobstructive plaques [26 (13%) of 201] (p less than 0.001). There was also a strong association between symptoms and plaque configuration. Mural plaques growing in a crescentic configuration along the wall of the carotid bifurcation between the first and second examination had a higher incidence of symptoms [22 (40%) of 56] than did plaques that grew but maintained a nodular configuration [8 (12%) of 65] (p less than 0.001), although the same proportion of each became hemodynamically obstructive. Sequential visualization of atherosclerotic plaques by real time B-mode ultrasonography of the carotid bifurcation may provide a method for studying the pathogenesis of arterial thrombosis.
局灶性脑血管疾病新症状的出现，包括完全性脑梗死、短暂性脑缺血发作和一过性黑矇，与通过实时B型超声检查可视化的颈动脉分叉处动脉粥样硬化斑块的大小和形态变化相关。在123例患者中，对246个斑块进行双侧系列成像，初始研究和随访研究之间的时间间隔为9至35个月。斑块增大的同侧出现症状的发生率[121个中的30个（25%）]显著高于斑块缩小或不变的同侧[98个中的8个（8%）]（p<0.001）。通过引起层流中断或眼动脉远端灌注压降低而在血流动力学上造成阻塞的斑块，其症状发生频率[30个中的12个（40%）]高于非阻塞性斑块[201个中的26个（13%）]（p<0.001）。症状与斑块形态之间也存在密切关联。在首次和第二次检查之间沿颈动脉分叉壁呈新月形生长的壁内斑块，其症状发生率[56个中的22个（40%）]高于生长但保持结节状形态的斑块[65个中的8个（12%）]（p<0.001），尽管每种斑块中血流动力学阻塞的比例相同。通过对颈动脉分叉进行实时B型超声检查对动脉粥样硬化斑块进行连续可视化，可能为研究动脉血栓形成的发病机制提供一种方法。
