Extracranial carotid atherosclerosis as an important predictor for silent brain infarction.
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概要
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To determine the clinical significance of the extracranial carotid atherosclerosis in silent brain infarction (SBI), we studied serial 117 neurologically-free subjects (62.0 ± 9.4 yo. : mean ± S.D.) with at least one of the following risk factors for stroke; hypertension, diabetes mellitus, hypercholesterolemia and ischemic heart disease. All subjects underwent B-mode ultrasonography and were divided into four groups of patients with no, mild, moderate and severe carotid atherosclerosis based on the severity of plaque score (Stroke 1990; 21 : 1567-1572). Maximum percent stenosis and the existence of ulcerated lesions in each vessel were also evaluated. SBI lesions were detected by 0.1 T MRI and were investigated for their number, size, and localization.<BR>The incidence of SBI was 42% in all subjects and significantly increased with advancing age. Most of the SBI lesions were smaller than 1 cm in diameter, and were localized in the subcortical white matter and in the basal ganglia. The incidence of subjects with no, mild, moderate or severe carotid atherosclerosis was 36%, 38%, 15% or 11%, respectively.<BR>Though the incidence of subjects with plaques did not increase significantly with advancing age, those with moderate or severe atherosclerosis increased significantly. Subjects with severe stenosis (≥50%) orulcerated lesions were chiefly belonged to severe atherosclerosis group.<BR>Although there were no significant differences in the SBI incidence between the subjects with plaques (47%) and those without (33%), SBI incidence increased significantly as the severity of plaque score increased (p<0.05) or when subjects had severe stenosis (p<0.05) or ulcerated lesions (p<0.01). These relationships were also noted in each decade of age (50s, 60s, and 70s). Especially in the subjects with severe stenosis or ulcerated lesions, higher incidence of larger lesions (>1 cm) was found in the brain hemisphere ipsilateral to the carotid lesions. As for the remaining risk factors, only hypertension was significantly related with the appearance of SBI.<BR>Both the severity and characteristics of carotid atherosclerosis estimated by B-mode ultrasonography were closely related to the appearance of SBI. These results demonstrated that noninvasive assessment of carotid atherosclerosis was quite useful to predict the appearance of SBI.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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