缺血性脑血管病二级预防
合集下载
相关主题
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
Dictionary
5
Prevalent Concepts
Embolism =Cardiac-origin embolism The hit rate is very high Treatment is based on the sourceanticoagulants for cardiac-origin embolism and antiplatelets for arterial source embolism
18
Size of Infarcts Stroke Data Bank
Size of infracts on CT scan -- Cardiac-origin embolism- the median volume of infracts was 2.4x that found in patients with intraarterial embolism 早期意识障碍发生率 -- 心源性 29.8% -- 动脉源性 6.1%
14
常见的栓塞部位
15
16
The recipient arteries are responsible fቤተ መጻሕፍቲ ባይዱr the clinical
presentation
What information is used to classify a stroke as embolic
17
Recipient arteries Factors favoring an embolic stroke mechanism
缺血性脑血管病二级预防
1
Disclosures
2
Contents
Brain Embolism? Donor Source Pathophysiology of Embolic particles Recipient Artery Treatment﹠Prevention Complications
24
Donor Source
Heart Aorta Cervico-Cranial Arteries Veins (Paradoxical Embolism)
20
21
Hemorrhagic transforamtion is an very important clue to an embolic mechanism
22
23
Contents
Brain Embolism? Recipient Artery Donor Source Pathophysiology Nature of Embolic Particles Treatment﹠Prevention Complications
8
9
Contents
Brain Embolism? Recipient Artery Donor Source Pathophysiology Nature of Embolic Particles Treatment﹠Prevention Complications
10
Brain Embolism Actors in the Drama
Undissolved material carried by the blood current and impacted in some part of the vascular system such as thrombi, tissue fragments, clumps of bacteria, fat globules, or air bubbles
6
Brain Embolism Clinical Features
危险因素 -- 动脉粥样硬化较少 -- 心脏病因素较多（如AF、心肌病、心 瓣膜病、心衰等 -- 主动脉弓病变 -- 头颈部大血管病变 -- 静脉血栓形成条件 -- 其他部位栓塞证据
7
临床提示栓塞的证据
TIA或小中风通常单次或发作频率较低，但单 次发作持续时间比较长 症状在一开始就达高峰，或阶梯式发展 有时在活动、咳嗽、打喷嚏时发作 梗塞灶可累及不同形态的多个血管区域 出血转化多见，也是较为特征性的影像学改变 可发现远端血管内栓子 梗塞灶常成楔形，位于皮质或皮质下 存在心脏、动脉或静脉栓子源的证据
19
Recipient arteries(At necropsy and imaging）
Open-no blockage Distal blockage beyond the infarct Abrupt occlusion without narrowing Absence of underlying AS or other intrinsic disease No attachment of thrombus to artery
Timing of symptoms--max at onset or one step within 24~48 hours Size of infarct Infarct location--cortical, cortical/subcortical Hemorrhagic transformation Appearance on vascular imaging of recepient artery--no important underlying AS, passage of blockage, shape of block, filling defect
3
Contents
Brain Embolism? Donor Source Pathophysiology Nature of Embolic Particles Recipient Artery Treatment﹠Prevention Complications
4
Definition of an embolus
Recipient Artery Donor Source -- Heart -- Aorta -- Cervico-Cranial Arteries -- Veins (Paradoxical Embolism) Embolic matter ( the “stuff” )
11
12
13
Clot in BA
5
Prevalent Concepts
Embolism =Cardiac-origin embolism The hit rate is very high Treatment is based on the sourceanticoagulants for cardiac-origin embolism and antiplatelets for arterial source embolism
18
Size of Infarcts Stroke Data Bank
Size of infracts on CT scan -- Cardiac-origin embolism- the median volume of infracts was 2.4x that found in patients with intraarterial embolism 早期意识障碍发生率 -- 心源性 29.8% -- 动脉源性 6.1%
14
常见的栓塞部位
15
16
The recipient arteries are responsible fቤተ መጻሕፍቲ ባይዱr the clinical
presentation
What information is used to classify a stroke as embolic
17
Recipient arteries Factors favoring an embolic stroke mechanism
缺血性脑血管病二级预防
1
Disclosures
2
Contents
Brain Embolism? Donor Source Pathophysiology of Embolic particles Recipient Artery Treatment﹠Prevention Complications
24
Donor Source
Heart Aorta Cervico-Cranial Arteries Veins (Paradoxical Embolism)
20
21
Hemorrhagic transforamtion is an very important clue to an embolic mechanism
22
23
Contents
Brain Embolism? Recipient Artery Donor Source Pathophysiology Nature of Embolic Particles Treatment﹠Prevention Complications
8
9
Contents
Brain Embolism? Recipient Artery Donor Source Pathophysiology Nature of Embolic Particles Treatment﹠Prevention Complications
10
Brain Embolism Actors in the Drama
Undissolved material carried by the blood current and impacted in some part of the vascular system such as thrombi, tissue fragments, clumps of bacteria, fat globules, or air bubbles
6
Brain Embolism Clinical Features
危险因素 -- 动脉粥样硬化较少 -- 心脏病因素较多（如AF、心肌病、心 瓣膜病、心衰等 -- 主动脉弓病变 -- 头颈部大血管病变 -- 静脉血栓形成条件 -- 其他部位栓塞证据
7
临床提示栓塞的证据
TIA或小中风通常单次或发作频率较低，但单 次发作持续时间比较长 症状在一开始就达高峰，或阶梯式发展 有时在活动、咳嗽、打喷嚏时发作 梗塞灶可累及不同形态的多个血管区域 出血转化多见，也是较为特征性的影像学改变 可发现远端血管内栓子 梗塞灶常成楔形，位于皮质或皮质下 存在心脏、动脉或静脉栓子源的证据
19
Recipient arteries(At necropsy and imaging）
Open-no blockage Distal blockage beyond the infarct Abrupt occlusion without narrowing Absence of underlying AS or other intrinsic disease No attachment of thrombus to artery
Timing of symptoms--max at onset or one step within 24~48 hours Size of infarct Infarct location--cortical, cortical/subcortical Hemorrhagic transformation Appearance on vascular imaging of recepient artery--no important underlying AS, passage of blockage, shape of block, filling defect
3
Contents
Brain Embolism? Donor Source Pathophysiology Nature of Embolic Particles Recipient Artery Treatment﹠Prevention Complications
4
Definition of an embolus
Recipient Artery Donor Source -- Heart -- Aorta -- Cervico-Cranial Arteries -- Veins (Paradoxical Embolism) Embolic matter ( the “stuff” )
11
12
13
Clot in BA