| Part One Objective to investigate the correlation between carotid artery bifurcation atherosclerotic plaque stability and acute cerebral infarction Objective To investigate the relationship between the stability of atherosclerotic plaque at carotid bifurcation and acute cerebral infarction,and to guide clinical development of individualized treatment.Method The clinical data of 111 patients with cerebral ischemia in our hospital were retrospectively analyzed.They were divided into cerebral infarction group(50 cases with unilateral acute cerebral infarction)and control group(61 cases without acute cerebral infarction,including normal or old cerebral infarction).The CTA energy spectrum CT data of carotid vessels in the two groups were analyzed.The number of detected atherosclerotic plaques at carotid bifurcation in the two groups was counted,and the carotid arteries in the two groups were observed.The morphology of atherosclerotic plaque was recorded,including whether the plaque was abnormal,whether the intima had ulcer or not,whether the intima had calcification or not.The composition of carotid atherosclerotic plaque was analyzed by energy spectrum CT in two groups with normal plaque morphology.Result The detection rate of atherosclerotic plaque at the bifurcation of the ipsilateral carotid artery was 98.00%(49/50)in cerebral infarction group and 50.82%(31/61)in control group,P < 0.05,with statistical significance.Among 49 cases of cerebral infarction combined with ipsilateral carotid atherosclerotic plaque,24 cases had abnormal plaque shape,accounting for 48.98%(24/49)in control group.There were 2 cases with abnormal state(6.45%(2/31),P < 0.05,the difference was statistically significant;the detection rates of plaque endometrial ulcer and calcification were 18.37%(9/49) and 36.73%(18/49)in cerebral infarction group,and 3.23%(1/31) and 3.23%(1/31) in control group,respectively.The difference was statistically significant.The detection rates of lipid plaque,hemorrhagic plaque and fibrous plaque in cerebral infarction group were 88.00%(22/25),20.00%(5/25)and 0.00%(0.00%)respectively./The detection rates of the control group were 6.67%(2/30),0.00%(0/30)and 93.33%(28/30),respectively(P < 0.05).Conclusion Unilateral acute cerebral infarction is correlated with the occurrence and stability of atherosclerotic plaques at the bifurcation of the same carotid artery.EDCT can evaluate the stability of carotid atherosclerotic plaques and has clinical significance for the treatment of patients with carotid atherosclerotic plaques.Part Two The value of head and neck CTA combined with one-stop brain perfusion in evaluating the prognosis of cerebral infarctionObjective: To explore the clinical value of carotid artery perfusion imaging as an independent predictor of clinical prognosis of stroke.Methods: 160 patients with stroke treated in our hospital from June 2018 to December2019 were selected and divided into vascular stenosis group(n=80)and vascular occlusion group(n=80)according to carotid artery perfusion imaging test results.Gender and age matched patients without cerebral vascular stenosis were selected as control group(n=80).All patients underwent carotid artery perfusion imaging and spiral CT cerebral perfusion imaging.The collected CT perfusion imaging images will be blindly evaluated by two physicians with more than one diagnosis.NIHSS will be used to assess the neurological function of stroke patients,and BI score will be used to assess the ability of daily life.MRS is used to assess the prognostic and functional disability level.The study was approved by the Hospital Ethics Committee and was conducted according to the principles of the Declaration of Helsinki and the norms of good clinical practice.The SPSS of Windows 24.0 statistical analysis software will be used for calculation,and normality test and uniform variance test will be performed on each group of data.Results: A total of 160 stroke patients were involved in this study,79 males(48.75%),82 females(51.25%),average age 57.25±7.45,BMI24.85±2.42,46 smoking patients(28.75%),34 drinking patients(21.25%).Choose healthy volunteers with matching gender and age as controls.The normal group,vascular stenosis group and vascular occlusion group had no difference in gender,age,BMI,smoking,and alcohol consumption(P>0.05).CBF volume,CBV volume,TPP and MTT of ischemic area in vascular stenosis group were increased,CBF and CBV were decreased(P < 0.05).CBF volume,CBV volume,TPP and MTT of ischemic area in vascular occlusion group were higher than those in vascular stenosis group,and CBF and CBV were lower(P < 0.05).Compared with the vascular stenosis group,the CBF volume,CBV volume,TPP and MTT increased in the vascular occlusion group,while the CBF and CBV decreased(P<0.05).There was no statistical difference between the NIHSS score,BI score and MRS score at 0d,30 d,60d and 90 d in the normal group(P>0.05).The NIHSS score and MRS score in the vascular stenosis group and vascular occlusion group decreased with the increase of treatment time,and the BI score Both increased with the increase of treatment time(P<0.05).The NIHSS scores and MRS scores of the vascular stenosis group at 0d,30 d,60d and 90 d were increased compared with the normal group,and the BI scores were lower than the normal group(P<0.05).At 0d,30 d,60d and 90 d,the NIHSS score and MRS score of the occlusion group were higher than those of the vascular stenosis group,and the BI score was lower than that of the normal group(P<0.05).Conclusion: Through head and neck CTA combined with brain perfusion one-stop examination,It can reflect the cerebral infarction caused by different degrees of cerebral vascular stenosis,and its prognosis is related to the degree of cerebral vascular stenosis;head and neck CTA combined with one-stop examination of cerebral perfusion can complete the evaluation of cerebral perfusion while finding cerebral vascular stenosis,which provides reference for early diagnosis and prognosis evaluation of patients with cerebral infarction. |
PDF Full Text Request