Imparato A M, Riles T S, Gorstein F
Stroke. 1979 May-Jun;10(3):238-45. doi: 10.1161/01.str.10.3.238.
Embolization from or decreased flow through cervical carotid and vertebral arteries causes ischemic stroke syndromes. Specific pathologic findings were studied in 50 symptomatic patients who underwent 69 carotid endarterectomies. Detailed analyses of their carotid plaques included correlations between photographs of gross specimens, microscopic findings, angiograms, preoperative symptoms and long-term postoperative follow up. Carotid plaques were primarily fibrous with significant (greater than 70%) stenoses encountered in 70% of the arteries. Stenoses were due to simple fibrous thickening in only 20%; the remainder due to intraplaque hemorrhage, atheromatous debris and, least often, luminal thrombus with or without ulceration. Intramural hemorrhage was frequent in plaques associated with focal neurologic symptoms and may have preceded localized collections of atheromatous debris. Ulceration occurred in 1/3 of all plaques, symptomatic or not. It is concluded that the carotid plaques start as fibrointimal thickening evolving to symptomatic stages by the occurrence of one or more of a number of pathologic changes, intraplaque hemorrhage being prominent. A single rational therapeutic regimen seems impossible until patients can be classified according to their pathologic changes diagnosed non-invasively.
颈内动脉和椎动脉的栓塞或血流减少会导致缺血性中风综合征。对50例有症状的患者进行了69次颈动脉内膜切除术，并研究了具体的病理发现。对他们的颈动脉斑块进行了详细分析，包括大体标本照片、显微镜检查结果、血管造影、术前症状和长期术后随访之间的相关性。颈动脉斑块主要为纤维性，70%的动脉出现显著（大于70%）狭窄。仅20%的狭窄是由于单纯纤维增厚；其余的是由于斑块内出血、粥样碎片，最不常见的是伴有或不伴有溃疡的腔内血栓。与局灶性神经症状相关的斑块内出血很常见，可能先于粥样碎片的局部聚集。所有斑块中有1/3发生溃疡，无论有无症状。结论是，颈动脉斑块始于纤维内膜增厚，通过发生多种病理变化中的一种或多种而发展到有症状阶段，斑块内出血较为突出。在能够根据非侵入性诊断的病理变化对患者进行分类之前，单一合理的治疗方案似乎是不可能的。
