缺血性卒中的病理特點(diǎn)和生理基本機(jī)制

1、缺血性卒中的病理特點(diǎn)和生理基本機(jī)制穿支動(dòng)脈疾病大動(dòng)脈病變心臟病變其他原因病理生理機(jī)制心臟病變病理生理機(jī)制心臟的栓子脫落房顫二尖瓣狹窄、人工瓣膜置換術(shù)后、過去的四周內(nèi)心梗、左心附壁血栓、左心室壁瘤、持續(xù)或陣發(fā)性房顫、病竇綜合癥、擴(kuò)張性心肌病、射血分?jǐn)?shù)20um）栓子外溢與血流再通情況栓子被完全外溢之前血流就已經(jīng)部分再通栓子及時(shí)外溢組織正常栓子不能及時(shí)外溢側(cè)枝不好組織壞死栓子完全外溢后血流才有可能再通更小的毛細(xì)血管栓子外溢與血流再通情況但是，到了毛細(xì)血管里的栓子幾乎都能很有效地被溢出到血管外，從而保證毛細(xì)血管的正常纖溶/沖刷栓子外溢栓子被清除掉了大動(dòng)脈粥樣硬化所致腦梗死的發(fā)病機(jī)制1、斑塊或血栓堵塞穿

2、支或分支動(dòng)脈 （顱內(nèi)有發(fā)出穿支的大動(dòng)脈）3、血流灌注下降+斑塊或血栓脫落 （栓子清除下降）2、斑塊或血栓脫落（動(dòng)脈-動(dòng)脈栓塞）病理生理機(jī)制大動(dòng)脈病變側(cè)枝代償前循環(huán)動(dòng)脈病變后循環(huán)動(dòng)脈病變病因粥樣硬化煙霧病大動(dòng)脈炎動(dòng)脈夾層其他發(fā)病機(jī)制粥樣硬化導(dǎo)致腦梗死煙霧病導(dǎo)致腦梗死大動(dòng)脈炎導(dǎo)致腦梗死動(dòng)脈夾層導(dǎo)致腦梗死其他導(dǎo)致腦梗死內(nèi)有血栓形成如何導(dǎo)致腦梗死的？煙霧病者管腔狹窄，那么，是狹窄后的低灌注直接導(dǎo)致的腦梗死嗎？Yasuyuki Iguchi ,at al. Takeshi Inoue. Microembolic signals are associated with progression of art

3、erial lesion in Moyamoya disease: A case report. Journal of the Neurological Sciences 260 (2007) 253255記錄到大量MES是血栓形成期，活動(dòng)、進(jìn)展10天后病理生理機(jī)制大動(dòng)脈病變側(cè)枝代償前循環(huán)動(dòng)脈病變后循環(huán)動(dòng)脈病變病因粥樣硬化煙霧病大動(dòng)脈炎動(dòng)脈夾層其他發(fā)病機(jī)制粥樣硬化導(dǎo)致腦梗死煙霧病導(dǎo)致腦梗死大動(dòng)脈炎導(dǎo)致腦梗死動(dòng)脈夾層導(dǎo)致腦梗死其他導(dǎo)致腦梗死大動(dòng)脈炎患者微栓子監(jiān)測18例TA患者4例MES(+)陽性率22%動(dòng)脈-動(dòng)脈栓塞直接證據(jù)Emre Kumral etc. Microembolus Detect

4、ion in Patients With Takayasus Arteritis. Stroke 2002;33;712-71610天后Yuji Kato etc. Stroke as a Manifestation of Takayasus Arteritis Likely due to Distal Carotid Stump Embolism. Inter Med 49: 695-699, 2010栓子來源？DTCD發(fā)泡試驗(yàn)排除右向左分流不支持心源性栓塞Yuji Kato etc. Stroke as a Manifestation of Takayasus Arteritis Like

5、ly due to Distal Carotid Stump Embolism. Inter Med 49: 695-699, 2010可能性不太大心臟檢查往往是正常的不允許大栓子通過CCA殘端Yuji Kato etc. Stroke as a Manifestation of Takayasus Arteritis Likely due to Distal Carotid Stump Embolism. Inter Med 49: 695-699, 2010CCA殘端血栓形成Yuji Kato etc. Stroke as a Manifestation of Takayasus Arte

6、ritis Likely due to Distal Carotid Stump Embolism. Inter Med 49: 695-699, 2010病理生理機(jī)制大動(dòng)脈病變側(cè)枝代償前循環(huán)動(dòng)脈病變后循環(huán)動(dòng)脈病變病因粥樣硬化煙霧病大動(dòng)脈炎動(dòng)脈夾層其他發(fā)病機(jī)制粥樣硬化導(dǎo)致腦梗死煙霧病導(dǎo)致腦梗死大動(dòng)脈炎導(dǎo)致腦梗死動(dòng)脈夾層導(dǎo)致腦梗死其他導(dǎo)致腦梗死如何導(dǎo)致腦梗死的？動(dòng)脈夾層管腔狹窄，那么，是狹窄后的低灌注直接導(dǎo)致的腦梗死嗎？D.H. Benninger, Mechanism of Ischemic Infarct in Spontaneous Carotid Dissection. Stroke.

7、2004;35:482-485.100%提示動(dòng)脈到動(dòng)脈栓塞機(jī)制低灌注/栓子清除下降（全部都有區(qū)域梗死，額外有交界區(qū)梗死）作者得出結(jié)論：頸內(nèi)動(dòng)脈夾層導(dǎo)致腦梗死的主要機(jī)制-是血栓栓塞性梗死（動(dòng)脈到動(dòng)脈栓塞）-而不是血流動(dòng)力學(xué)導(dǎo)致的低灌注梗死不是動(dòng)脈狹窄后低灌注導(dǎo)致梗死而是動(dòng)脈狹窄后血栓形成脫落導(dǎo)致的栓塞性梗死病理生理機(jī)制大動(dòng)脈病變側(cè)枝代償前循環(huán)動(dòng)脈病變后循環(huán)動(dòng)脈病變病因粥樣硬化煙霧病大動(dòng)脈炎動(dòng)脈夾層其他發(fā)病機(jī)制粥樣硬化導(dǎo)致腦梗死煙霧病導(dǎo)致腦梗死大動(dòng)脈炎導(dǎo)致腦梗死動(dòng)脈夾層導(dǎo)致腦梗死其他導(dǎo)致腦梗死發(fā)病機(jī)制粥樣硬化導(dǎo)致腦梗死煙霧病導(dǎo)致腦梗死大動(dòng)脈炎導(dǎo)致腦梗死動(dòng)脈夾層導(dǎo)致腦梗死其他導(dǎo)致腦梗死狹窄處血栓形成，脫落導(dǎo)致動(dòng)脈到動(dòng)脈栓塞是動(dòng)脈狹窄后導(dǎo)致腦梗死最重要的發(fā)病機(jī)制病理生理機(jī)制心臟的栓子脫落大動(dòng)脈病變房顫非房顫其他心臟疾病粥樣硬化煙霧病大動(dòng)脈炎動(dòng)脈夾層其他原因血栓或斑塊堵塞分支、動(dòng)脈到動(dòng)脈栓塞、灌注降低穿支動(dòng)脈疾病大動(dòng)脈病變心臟病變其他原因纖維玻璃樣變/脂質(zhì)玻璃樣變Chen XY, Wong KS, et al. Cerebrovasc Dis. 2008. 25(1-2): 74-80. Klein IF, et al. Cere