Distribution, severity and risk factors for aortic atherosclerosis in cerebral ischemia.
Distribution, severity and risk factors for aortic atherosclerosis in cerebral ischemia.
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脑缺血时主动脉粥样硬化的分布、严重程度和危险因素。
DOI：
10.1159/000016038
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
Oppenheimer,SM
中科院分区：
文献类型：
--
作者：
Sen,S;Wu,K;McNamara,R;Lima,J;Piantadosi,S;Oppenheimer,SM
显著的胸主动脉斑块（> 4 mm）是缺血性卒中的独立危险因素。在卒中/短暂性脑缺血发作（TIA）发作1周内，105例连续患者接受经食管超声心动图评估，采用Amarenco等人的标准评估主动脉斑块厚度。（N Engl J Med 1994; 331：1474-1479）。在> 4 mm的主动脉粥样硬化分布中发现近端-远端梯度（p= 0.04）。症状性冠状动脉疾病与近端主动脉斑块相关（p= 0.03）;颅外颈动脉狭窄> 70%与主动脉弓和降主动脉斑块相关（p< 0.01）。多变量分析显示，主动脉斑块的严重程度与年龄相关（p= 0.0003至p< 0.01）。只有吸烟显示出预测区域特异性（p= 0.03）;没有其他危险因素与任何节段的主动脉粥样硬化相关。在卒中/TIA患者中，颈动脉狭窄> 70%预示着主动脉弓粥样斑块> 4 mm，这可能使动脉内膜切除术后再梗死易感。升主动脉粥样硬化与缺血性心脏病相关，无症状患者应考虑进行心脏筛查。
Significant thoracic aortic plaques (> 4 mm) are an independent risk factor for ischemic stroke. Within 1 week of stroke/transient ischemic attack (TIA) onset, 105 consecutive patients underwent transesophageal echocardiography assessment of aortic plaque thickness using the criteria of Amarenco et al.(N Engl J Med 1994; 331: 1474–1479). A proximo-distal gradient was found in the distribution of aortic atheroma> 4 mm (p= 0.04). Symptomatic coronary artery disease was associated with plaque in the proximal aorta (p= 0.03); extracranial carotid stenosis> 70% was associated with plaque in the arch and descending aorta (p< 0.01). The severity of aortic plaque was associated with age on multivariable analysis (p= 0.0003 to p< 0.01). Only smoking showed predictive regional specificity (p= 0.03); no other risk factors were associated with aortic atheroma in any segment. In stroke/TIA patients, carotid stenosis> 70% predicts aortic arch atheroma plaques> 4 mm which may predispose to reinfarction after endarterectomy. Atheroma of the ascending aorta is associated with ischemic heart disease, and cardiac screening should be considered in asymptomatic patients.