The Study Of The Carotid Artery Plaques As Well As The Carotid Artery Stenosis In Patients With Ischemic Cerebrovascular Disease By CTA

Part 1 The value of CTA in the diagnosis of carotid artery stenosisObjective: To evaluate the value of CTA in the diagnosis of carotid artery stenosis in ischemic cerebrovascular disease (ICVD) patients.Methods: 23 cases(46 carotid arteries) have anterior circulation in patients with cerebral ischemic symptoms.They were underwent dual-source 64-slice CT scan machine, reconstructed by multi-planar reconstruction(MPR), curved planar reconstruction(CPR), maximum intensity projection(MIP) and volume reddering(VR) technology to measure the axial vessel diameter as the extended. And all patients underwent DSA operation. Reference to the North American Symptomatic Carotid Endarterectomy Trial(NASCET) criteria grading of vascular stenosis. With the results of DSA as the standard to observe the sensitivity, specificity, positive predictve value and negative predictive value of the CTA in the diagnosis of carotid artery stenosis.Results: The results of 46 carotid arteries in 23 patients diagnosed by DSA, the proportion of no stenosis was 45.7% (21/46), complete occlusion was 4.3% (2/46), varying degrees of stenosis accounted for 50.0% (23/46). CTA and DSA in full compliance with inspection for 43, accounting for 93.5%; and higher for two, accouting for 4.3%, lower for one, accounting for 2.2%. In 46 internal carotid arteries of 23 patients diagnosed by DSA, no stenosis accounted for 28.3% (13/46), complete occlusion accounted for 4.3% (2/46), varying degrees of stenosis accounted for 67.4% (31/46). CTA and DSA in full compliance with inspection for 39, accounting for 84.8%; and higher as 6 arteries, accounting for 15.2%, lower for one, accounting for 2.2%. With DSA as the gold standard, the diagnosis rates of 30% and 70% of common carotid artery stenosis by CTA in line with the DSA were 93.5% and 97.8%. The diagnosis rates of 30% and 70% of internal carotid artery stenosis by CTA in line with the DSA were 91.3% and 95.7%. And then to DSA as the dependent variable, CTA as the independent variable, regression analysis showed that the CTA was positive correlated with DSA in the diagnosis of carotid artery stenosis, P<0.01. In the CTA axial, it can be clearly shown as the carotid artery stenosis, and to be able to show the size , number, shape and nature of the plaques.Conclusion: CTA has a hign degree of correlation with DSA in the diagnosis of carotid artery stenosis, and it can be used as a routine screening method in diagnosis of carotid artery stenosis.Part 2 The study of the carotid artery plaques as well as the carotid artery stenosis in patients with ischemic cerebrovascular disease by CTAObjective: To detect the distribution and the nature of carotid plaque, the distribution characteristics of carotid artery steosis of the patients who with ischemic cerebrovascular disease, and then to investigate the relationship between ischemic cerebrovascular disease and carotid artery plaques and carotid stenosis. At the same time, we analyse the risk factors of ischemic cerebrovascular disease, in order to find a reasonable and effective prevention and treatment of ischemic cerebrovascular disease.Methods: With 143 cases of ischemic cerebrovascular disease in December 2008 to February 2010 in our hospital as the experimental group, and to the same period, 67 cases of patients who with no ischemic cerebrovascular disease as the control group. All patients were underwent 64-slice spiral CT angiography to detect the bilateral carotid arteries (common carotid artery, extracranial and intracranial segment of internal carotid artery), in order to detect the type of plaque, the degree of stenosis of these arteries.Results: In 143 cases of patients who suffered from ischemic cerebrovascular disease, only 14 cases (9.8%) did not detected any obvious plaques, the detection rate of carotid artery plaque in patients who suffered from ischemic cerebrovascular disease was 90.2%, which was significantly higher than patients who with non-ischemic cerebrovascular disease. In 143 cases of ischemic cerebrovascular disease patients, the majority of them had more artery plaque formation, of which 84.6% of patients were detected carotid artery plaque in at least two carotid arteries, and 81.8% of patients with ischemic cerebrovascular disease were detected carotid artery plaque in both carotid artery and therefore the detection rate of multi-vessel plaque in ischemic cerebrovascular disease patients was more than in patients with non-ischemic cerebrovascular disease. In the common carotid artery, there were more soft plaques, while in the intracranial segment of internal carotid artery, there were more hardware, the difference was significant. 18.2% of patients who suffered from ischemic cerebrovascular disease existed mild stenosis in carotid artery, 23.1% of them existed moderate stenosis, 18.9% of them had severe carotid artery stenosis, and 8.4% of them with carotid artery total occlusion. The detection rate (68.5%) of carotid artery stenosis in ischemic cerebrovascular disease patients was significantly greater than the non-ischemic cerebrovascular disease (29.9%), the difference was statistically significant. In 143 cases of patients who suffered from ischemic cerebrovascular disease, the proportion of patients who with hypertension (76.2%) was significantly higher than the non-ischemic cerebrovascular disease (46.3%); the proportion of lipid disorders (94.4%) was significantly higher than the non-ischemic cerebrovascular disease(68.7%), the difference was statistically significant. Although diabetes proportion (34.3%) was higher than in non-ischemic cerebrovascular disease group (25.4%), this difference was not statistically significant. Through multi-regression analysis, it showed that hypertension and dyslipidemia were independent risk factors of ischemic cerebrovascular disease.Conclusion: Plaque formation and stenosis of carotid artery were main reasons for ischemic cerebrovascular disease. The stenosis in internal carotid artery was more often than in common carotid artery, and in the intracranial segment of internal carotid artery, hard plaques were dominated. In the common carotid artery, although the artery stenosis was relatively less compared with internal carotid artery, the types of the plaque were mainly soft plaques, thus it can be inferred that in Chinese people, resulting in ischemic cerebrovascular disease was mainly due to the drop off of the instable plaque in common carotid artery and the insufficient blood supply caused by internal carotid artery stenosis. Hypertension and dyslipidemia were closely related to ischemic cerebrovascular disease, and they were independent risk factors.