主动脉粥样硬化的诊断与治疗.ppt

Kronzon,etal.Circulation.2006;114:63-75.Tunick,etal.AJRAmJRoentgenol.2000;174(4):1119-25Kronzon,etal.Circulation.2006;114:63-75Tunick,etal.AJRAmJRoentgenol.2000;174(4):1119-25.TEE的缺陷一定程度的不适感，食道、咽部损伤（罕见）。由于气管和左主支气管造成的盲点，升主动脉远端和主动脉弓近端不能观测。EAUS在开胸手术中进行。不可能用于常规主动脉的检查。可作为“金标准”评价TEE诊断AA的准确性。以EAUS的结果为金标准，TEE诊断升主动脉AASensitivity：21％Speciticity：100％Zaane,etal.ActaAnaesthesiolScand2008;52:1179–1187IVUS分辨率高。有创，难以广泛开展，价值有限。MRICE-MRAT1WI（BlackBloodTechnique)、PDWI、T2WIHarloff,etal.JNeurolNeurosurgPsychiatry2008;79:540–546Fayad,etal.Circulation2000;101;2503-2509Fayad,etal.Circulation2000;101;2503-2509GuidelinesIschaemicStroke2008GuidelinesIschaemicStroke20082700例10-64岁，外界因素（暴力），非卒中、冠心病、糖尿病、高血压以外的自然死亡Strongandcolleagues3studied2700peopleage10–64yearsatautopsyinNewOrleansbetween1960and1968.Causeofdeathwasexternalviolenceornaturalcausesotherthancoronaryheartdiseaseorrelateddisorderssuchasstroke,diabetes,orhypertension;70%ofautopsiesweredonebytheCoroner’sOffice.Althoughthisgroupmaynotbetrulyrepresentative,withover-representationofmalesandpossibly—giventhemodeandageofdeath—ofthosefrommoresociallydeprivedbackgrounds,theseriesdoesprovideevidenceforaprogressiveincreaseintheburdenofraisedatheroscleroticlesionsfromanaverageof0·4%oftheintimalsurfaceinpatients15–24yearsold,4·9%inthoseage25–34years,12·1%inthoseage35–44years,22·5%inthoseage45–54years,to33%inpatientsbetweentheagesofTheStrokePrevention:AssessmentofRiskintheCommunity(SPARC)studyhasexaminedanageandgenderstratifiedrandomsampleof581peopleoverage44yearsinOlmsteadCountyMinnesota,USA.13AllhadTOE,andatheromawasidentifiedin51·3%ofpatients;7·6%hadsevereatheroma(4mmthick,ulceratedormobile).Amarencoandcolleagues1havereportedareviewof500consecutiveautopsiesofpatient