首页 中华神经科杂志 2017年50卷8期 中国头颈部动脉粥样硬化诊治共识
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ENGLISH ABSTRACT
中国头颈部动脉粥样硬化诊治共识
中华医学会神经病学分会 
中华医学会神经病学分会脑血管病学组
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1006-7876.2017.08.003
Consensus on diagnosis and treatment of cerebral and carotid atherosclerosis in China
Chinese Society of Neurology
Cerebrovascular Disease Society, Chinese Society of Neurology
Authors Info & Affiliations
Chinese Society of Neurology
Cerebrovascular Disease Society, Chinese Society of Neurology
·
DOI： 10.3760/cma.j.issn.1006-7876.2017.08.003
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中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国头颈部动脉粥样硬化诊治共识[J]. 中华神经科杂志,2017,50(8)：572-578.
DOI:10.3760/cma.j.issn.1006-7876.2017.08.003PERMISSIONS
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缺血性脑卒中发病率、致残率和死亡率高，给社会和家庭带来了沉重的经济负担，成为影响中老年人健康的主要原因
[
1
,
2
,
3
]。2013年，一项覆盖中国31个省、市，包括城市和农村地区48万余名20岁以上成年人的随机抽样调查结果显示：脑卒中发病率为345.1/10万，脑卒中死亡率为159.2/10万
[
1
]。在缺血性脑卒中的防治中，不仅要重视高血压、糖尿病、血脂异常、肥胖、吸烟等危险因素，还应重视头颈部动脉粥样硬化的评估与治疗。
头颈部动脉狭窄是动脉粥样硬化发展的严重阶段。伴有头颈部动脉狭窄的脑卒中是导致严重残疾与死亡的主要类型。2014年中国一项22个中心、纳入2 864例发病在7 d内的急性缺血性脑卒中患者的前瞻性登记研究显示，颅内动脉狭窄发生率为46.6%，其中9.11%合并颈动脉与椎动脉颅外段狭窄
[
4
]。这项研究还提示，伴有头颈部动脉狭窄或闭塞的脑卒中患者入院时症状、体征更严重，住院时间更长，复发性脑卒中比例更高。所以，头颈部动脉狭窄应作为脑卒中发生前一级预防的重要干预目标。
随着影像学检查与脑血管介入技术的发展，对头颈部动脉粥样硬化的观察越来越全面细致，与病理学诊断越来越接近。头颈部血管影像学诊断报告可以给出血管病变部位，并且对动脉存在斑块及性质、动脉发生狭窄及狭窄程度描述得十分详细。但是，相比之下临床诊断却显得过于简单，也缺乏统一的、公认的诊断分类。而在未发生脑梗死的头颈部动脉粥样硬化性病变中，对轻度狭窄或未导致狭窄仅表现为斑块或内中膜增厚的血管病变应该怎样恰当处理等问题，已发表的指南或共识均未涉及。哪些需要治疗？怎样合理治疗？这些属于临床热点但争议很大的问题却尚无共识发表。所以，迫切需要建立统一的中国头颈部动脉粥样硬化的临床诊断分类与治疗原则。建立这项诊治规范，对统一血管超声、影像学和临床诊断以及药物治疗、颈内动脉剥脱术(CEA)与颈动脉支架植入术(CAS)手术风险的评估，有重要的指导意义。
本项共识所提的头颈部动脉为：头部动脉包括颈内动脉与椎动脉颅内段，大脑中动脉，大脑前动脉，大脑后动脉和基底动脉；颈部动脉包括颈动脉与椎动脉颅外段，以及锁骨下动脉和头臂动脉。头颈部动脉粥样硬化性病变主要包括动脉斑块形成、狭窄和闭塞，以及颈动脉内中膜增厚。
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备注信息
A
周华东，400042 重庆，第三军医大学大坪医院神经内科，Email:
mocdef.3ab61dauhuohz；刘鸣，610041 成都，四川大学华西医院神经内科，Email:
mocdef.labiamtohhmlpyw；蒲传强，100853 北京，解放军总医院神经内科，Email:
nc.defanabis82103qcup
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