TIA临床概念的进展黄一宁

1、1会计学TIA临床概念的进展黄一宁临床概念的进展黄一宁心源性栓子动脉到动脉栓子Figure 1. A large region of DWI and ADC imaging abnormality in the right temporal lobe in a patient with a left hemiparesis that rapidly resolved within 5 hours of onset. Other slices (not shown) demonstrated frontal and parietal regions of abnormality. a, DWI

2、image; b, ADC image; and c, baseline T2-weighted image. Figure 2. Several foci of left cerebellar DWI and ADC abnormality in a patient presenting with 6 hours of vertigo and left-arm clumsiness. Other slices (not shown) also showed foci of right cerebellar DWI abnormality. Follow-up MRI at 3 months

3、did not show corresponding late ischemic changes on T1- or T2-weighted images. a, DWI image; b, ADC image; c, baseline T2-weighted image; and d, late (follow-up) T2-weighted image. ADC 容积 (mm3)平均ADC强度经典定义（10万）组织定义（10万）TIA归类梗死（10万）2000年美国组织定义TIA2000年美国组织定义卒中中位数低高64371074325722112351204936966020100088

4、0528855491920181NINDS Results*Levy DE Neurology 1988;5:674-77*Lyden P et al;2001:57:2125-2128%研究药物（计量）观察时间（年）预后（卒中和TIA)治疗效果（相对危险性显著性检验4SSimvastatin(20/40mg) 5.4Totol stroke-30%NS4SSimvastatin (20/40 mg) 5.4Stroke+TIA-28%P=0.033CAREPravastatin (40mg)5Stroke-32%P=0.030LIPIDPravastatin(40mg)6Stroke-19%

5、P=0.050LIPIDPravastatin(40mg)6Ischemic stroke-23%HPSSimvastatin(40mg)5Stroke-25%P=0.0001HPSSimvastatin(40mg)5Ischemic stroke-30%P=0.0001HPSSimvastatin(40mg)5Fatal stroke-20%NSPROSPERPravastatin (40mg)3.2Stroke+TIA-0.96NSPROSPERPravastatin(40mg)3.2TIA-25%P=0.051ASCOTAtorvastatin(10mg)3.3Stroke-27%P=0

6、.0236Plaque with stable fibrous cap formation :mod. nach Ross R, N Engl J Med 340 (1999) & Falk et al., Circulation 92 (1995)Fibrous cap formationMacrophageaccumulationFormation ofnecrotic corePathophysiology of Atherosclerosis (III)Vessel wallCoronary plaque with lipid corePlaque-ACE and Athero

7、sclerosis Major role in atherosclerotic pathways:Endothelial dysfunctionThrombosisInflammationVasoconstrictionVascular lesionsRemodelingPlaquerupturePlaque-ACELocal Mediators VCAMICAMCytokinesEndothelinPAI-1Growth factorsProteolysisAng IIBradykinin NOClinical SequelaeAng IIadapt. from Pepine C, Can

8、J Cardiol 14; suppl D (1998)心源性栓子动脉到动脉栓子研究药物（计量）观察时间（年）预后（卒中和TIA)治疗效果（相对危险性显著性检验4SSimvastatin(20/40mg) 5.4Totol stroke-30%NS4SSimvastatin (20/40 mg) 5.4Stroke+TIA-28%P=0.033CAREPravastatin (40mg)5Stroke-32%P=0.030LIPIDPravastatin(40mg)6Stroke-19%P=0.050LIPIDPravastatin(40mg)6Ischemic stroke-23%HPSSimvastatin(40mg)5Stroke-25%P=0.0001HPSSimvastatin(40mg)5Ischemic stroke-30%P=0.0001HPSSimvastatin(40mg)5Fatal stroke-20%