A Clinical Study On The Dangerous Factors Of The Instability Of Carotid Plaques In Patients With Ischemic Cerebrovascular Diseases

Cerebrovascular disease is one of the most common causes of disability and one of the top three leading causes of death in mankind, and it has high ratios of incidence and recurrence, in all cerebrovascular diseases, about 80 percent of the patients are ischemic cerebrovascular patients. Atherosclerosis in the extracranial arteries has long been recognized as the most frequent pathological substrate of ischemic cerebrovascular disease. Carotid atherosclerosis may results in brain ischemia either through direct hemodynamic impact on the cerebral blood circulation or as a source of thromboembolic material. A long time in the past people paid much more attentions on the carotid stenoses, cared more about the degree of stenoses of the lumen with atherosclerosis. Recent series progressive studies showed that direct hemodynamic impact on the cerebral blood circulation is only a small part of the causes of ischemic stroke, and the carotid debris released off the carotid plaques are the most important reasons of ischemic cerebrovascular diseases, so the instability of the carotid atherosclerosis plays an important role in the ischemic cerebrovascular disease. Therefore studies on the instability of the carotid atherosclerosis appear much more important. The concept of instability of carotid plaque include 2 aspects : (1)the components of the carotid plaques are prone to release into the blood stream, make the plaques become sources of embolism ; (2) the structure of the plaques is unstable andprone to develop rapidly in a short time, lead to a serious stenosis of the lumen even occlusion, such as thrombosis and introhemorrhage. The histomorphological characteristics of a unstale plaque include: plaque with a bigger lipid core and a thinner fibrous cap; plaque with fibrous cap ruptured underlying thrombus; plaque with a necrotic core under its fibrous cap; the necrotic core is near to the fibrous cap ; plaque with local thinning of a fibrous cap; intraplaque hemorrhage of a plaque; plaque with ulceration on its surface; now high-resolution B-mode ultrasonography has been widely used for the purpose in detecting these morphologic characteristics, and its ability to characterize carotid plaques is currently considered a major advantage over other methods such as MRI, CT and arteriography. 112 cases of ischemic cerebrovascular disease in the department of Neurology of the first affiliated hospital of Zhengzhou University were included in present study, we classified these 112 patients to 3 groups according to their carotid ultrasonography , named normal carotid artery group, stable plaque group and unstable plaque group. Investigated respectively their dangerous factors, blood lipid and lipoprotein concentration, blood inflammatory factors,carotid lumenal stenosis degree. Try to draw a conclusion on the facts about the instability of carotid plaque, to know whether above dangerous factors are still the dangerous factors of the instability of carotid atherosclerosis;to explore the relationship between the instability of carotid plaque and blood lipid ,lipoprotein ,part inflammatory factors; to demonstrate whether there is a necessary correlation between the degree of carotid stenosis and the instability of carotid atherosclerosis, if the unstable carotid plaques are the inevitable goals of a stable plaque through the progressive course of a plaque . Subjects and methodsOver a 1-year period during 2002.12-2003.12 in the department of Neurology of the first affiliated hospital of Zhengzhou University, 112 patients with ischemic cerebrovascular diseases were involved in according to the strict rules of inclusion and exclusion , all patients were verified by history, physical examination and CT or MRI of brain . there were 68 male patients and 44 female patients, from 34 to 86 yearsold, the everage age of them is 62. among them there were 61 cerebral infarction patients ,35 lacunar infarction patients and 16 TIA patients. All patients were examined bilateral carotid arteries with the use of color duplex ultrasonography...