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世界核心医学期刊文摘（神经病学分册） 2005年第5期1卷 61-62页

作者： Alam.witch S. eliasziw m. Barnett H.J.m. 雷翀 Dept. of Com.unity Health Sciences University of Calgary 3330 Hospital Drive NW Calgary Alta. T2N 4N1 Canada Dr.

Background and Purpose -Perioperative risk and long-term.benefit of carot id endarterectom. (CE) are not detailed in wom.n with sym.tom.tic internal carot id artery (ICA) stenosis. Our aim.was to com.are the efficacy of CE versus m.dic al therapy in wom.n and m.n with sym.tom.tic ICA stenosis. m.thods -Data were taken from.the North Am.rcan Sym.tom.tic Carotid Endarterectom. Trial (873 wom. n, 2012 m.n) and the ASA and Carotid Endarterectom. trial (335 wom.n, 813 m.n). Results -The 30-day perioperative risk of death was higher in wom.n than in m.n (2.3% versus 0.8% , P=0.002). Higher perioperative risk of stroke and dea th was also observed (7.6% versus 5.9% ) but not statistically significant. W ith ≥ 70% stenosis, the 5-year absolute risk reduction (ARR)-in stroke fr om.CE was sim.lar between wom.n (15.1% ) and m.n (17.3% ). With 50% to 69% stenosis, CE was not beneficial in wom.n (ARR=3.0% , P=0.94), contrary to m.n (ARR=10.0% , P=0.02). m.dically treated wom.n had low risk for stroke. A stroke prognosis instrum.nt (SPI-II) assigned points to 7 factors that identified hi gher risk for m.dically treated wom.n: 3 points for hem.spheric (not retinal) ev ent, history of diabetes, previous stroke; 2 for age older than 70 years, stroke (not transient ischem.c attack); 1 for severe hypertension, history of m.ocardi al infarction. CE was beneficial only for 29.0% of wom.n with 50% to 69% s tenosis who had the highest total score of 8 to 15 (ARR=8.9% ). Conclusions - Wom.n and m.n with ≥ 70% sym.tom.tic stenosis had sim.lar long-term.benefit from.CE,although the perioperative risks were higher for wom.n. CE was not bene ficial for wom.n with 50% to 69% stenosis without other risk factors for str oke.

关键词：颈内动脉剥离术围手术期心肌梗死病史显著性差别药物治疗降低率死亡风险高风险因素预测方法

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CTA来源ASPECTS与未增强CT的比较研究:预测梗死范围和临床预后的价值

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世界核心医学期刊文摘（神经病学分册） 2005年第4期1卷 55-55页

作者： Coutts S.B. Lev m.H. eliasziw m. 张玉龙 Seam.n Fam.ly m. Centre Foothills Hospital 1403 29thST NW CalgaryAlta. T2N 2T9 Canada Dr

Background and Purpose - The Alberta Stroke Program.Early CT Score (ASPECTS) is a grading system.to assess ischem.c changes on CT in acute ischem.c stroke. CT angiographysource im.ges (CTA- SI) predict final infarct volum.. We exam.ned whether the final infarct ASPECTS and clinical outcom. were m.re related to acute CTA- SI ASPECTS than to the acute noncontrast CT (NCCT) ASPECTS. m.thods - ASPECTS was assigned by 2 raters on the acute NCCT, CTA- SI, and follow- up im.ging. The m.an baseline ASPECTS of acute NCCT and CTA- SI was com.ared with the follow- up ASPECTS. Rate ratios (RRs) were used to quantify the relationship between the dichotom.zed baseline ASPECTS (categorized as 0 to 7 versus 8 to 10) and favorable patient outcom.. Results - Thirty- nine patients were recruited. Proxim.l occlusion (internal carotid artery or m.ddle cerebral artery) was seen in 62% , m. occlusion in 18% , and no occlusion was seen in 20% of patients. The m.dian tim. between sym.tom.onset and im.ging was 1.9 (1.2 to 2.5) hours. There was a significantly larger difference of 1.4 between the m.an baseline NCCT and CTA- SI ASPECTS in patients who had m.re ischem.c changes (follow up ASPECTS=0 to 3) than a difference of 0.6 in patients who had near- to- norm.l CT scans (follow- up ASPECTS=8 to 10). The rate of favorable outcom. for acute NCCT ASPECTS of 8 to 10 was 51.8% versus 25.0% for 0 to 7 (RR, 2.1, 95% Cl: 0.7 to 5.9, P=0.12). For acute CTA- SI ASPECTS of 8 to 10, the rate of favorable outcom. was 58.8% versus 31.8% for 0 to 7 (RR. 1.8, 95% CI: 0.9 to 3.8, P=0.09). Conclusions - CTA- SI ASPECTS provides added inform.tion in the prediction of final infarct size.

关键词： CTA 梗死范围 ASPECTS 急性期梗死体积大脑中动脉颈内动脉评定者对比性血管造影

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