经颅（TCD）常规应用主要包含：
脑动脉狭窄与闭塞的诊断，侧枝代偿的判断；
脑血流微栓子监测；
蛛网膜下腔出血（SAH）脑动脉痉挛的监测；
卵圆孔未闭筛查（发泡试验）
......
--北京协和医院徐蔚海教授（德力凯台历TCD应用章节）
《HindawiDisease MarkersVolume 2019, Article ID 3090364, 7 pages》
作者：Yanyan Cao, Congxian Cui, Hongqin Zhao , Xudong Pan , Wenjian Li, Kun Wang , and Aijun Ma
【Abstract】
Background Instability of atherosclerotic plaques is associated with the occurrence of stroke. Microembolic signals (MESs) are anindicator of unstable plaque. A relationship between plasma osteoprotegerin (OPG) and ischemic stroke has already beenidentifified. The aim of this study was to investigate whether plasma OPG levels have a relationship with MESs and to evaluatethe feasibility of OPG as a biomarker of stroke severity and occurrence of MESs.
Methods Our study consisted of 127 patientswith large artery atherosclerosis stroke and 56 controls. Patients were classifified into subgroups based on stroke severity andthe occurrence of MESs. MES-monitoring was performed for 60 min using transcranial Doppler 【Delica EMS-9EB】within 72 h of strokeonset. Stroke severity at admission was assessed by the National Institutes of Health Stroke Scale.
Results Plasma OPGlevels were signifificantly associated with stroke, MESs, and stroke severity at admission (adjusted OR [95% CI]: 1.002[1.001–1.003] p < 0 001; 1.002 [1.001–1.003] p = 0 001; 1.001 [1.000–1.002] p = 0 028). When plasma OPG levels were used todetermine the stroke severity, the area under the receiver-operating characteristic curve (AUC) was 0.734 (95% CI: 0.625-0.843)based on a cutoffff value of 1998.44 pg/ml; the sensitivity and specifificity of this test were 80.6% and 65.6%, respectively.Furthermore, when the levels of OPG were used to distinguish the presence of MESs, the AUC was 0.766 (95% CI: 0.672-0.860);the cutoffff value was 2107.91 pg/ml. The sensitivity of this cutoffff value was 68.8% and the specifificity was 73.7%.
Conclusions Plasma OPG levels correlate with stroke severity and the occurrence of MESs.
（Interactive CardioVascular and Thoracic Surgery 26 (2018) 834–839）
作者：Rudolf W.M. Keunen-Department of Neurology, Haga Teaching Hospitals, Leyweg 275, 2545 CH The Hague, Netherlands
OBJECTIVES: Reducing the rate of postoperative stroke after cardiac surgery remains challenging, especially in patients with occlusive cerebrovascular disease. Angioplasty in all patients with high-grade carotid artery stenosis has not been shown to be effective in reducing thepost-surgical stroke rate. In this study, we present the initial results of a different approach using selective carotid angioplasty only inpatients with poor intracranial collaterals.
METHODS: We conducted a single-centre study to assess the safety of this procedure. The postangioplasty complication rate of the studygroup was compared to that of patients who were scheduled for symptomatic carotid artery angioplasty. To determine the effectiveness ofthis procedure, the post-cardiac surgery complication rate of the study group was compared with that of the matched case controls.
RESULTS: Twenty-two patients were treated with selective carotid angioplasty without developing persistent major neurological complications. All patients except 1 patient subsequently underwent surgery without developing persistent major neurological disabilities. Twopatients died of cardiogenic shock within 30 days.
CONCLUSIONS: Selective carotid angioplasty prior to cardiac surgery in patients with a presumed high risk of stroke was relatively safeand effective in this study group. Although this strategy does not prevent stroke in these high-risk patients, data suggest that this approachshifts the postoperative type of stroke from a severe haemodynamic stroke towards a minor embolic stroke with favourable neurologicaloutcomes. Larger studies are needed to determine whether this strategy can effectively eliminate the occurrence of haemodynamic strokeafter cardiac surgery.
（Echocardiography.2014 Nov;31(10):1283-92）
作者：He Yitao, M.D；Guo Yi, M.D., Ph.D., Department of Neurology, ShenzhenPeople’s Hospital
（中国组织化学与细胞化学杂志第22卷第４期2013年８月）
作者：陆首玲 梅志忠 李龙宣 彭兰芬
〔摘要〕
目的 探讨 ＴＣＤ微栓子（ＭＥＳ）监测及超敏 Ｃ反应蛋白和白介素－６检测在２型糖尿病合并急性脑梗死发病中的意义。
方法 序贯收集２０１１年１月至２０１２年６月在我院神经内科住院的首次前循环脑梗死患者９０例，根 据 是 否 合 并２型糖尿病分为糖尿病合并脑梗死组（观察组）４５例，单纯急性脑梗死组４５例（脑梗死组），另外，随机收集同期我院内分泌科首次住院的单纯２型糖尿病患者４５例（糖尿病组），监测三组患者病灶侧大脑中动脉（ＭＣＡ）微栓子阳性率及微栓子数目，血 清超敏 Ｃ反应蛋白及白介素－６值，分析三组患者中微栓子及相关炎性因子检测的意义。
结 果 观察组脑血管微栓子监测数量和 Ｈｓ－ＣＲＰ血清检测水平较脑梗死组和糖尿病组均显著增高（Ｐ＜０．０５和Ｐ＜０．０１）。观察组和脑梗死组血清白介素－６检测水平与糖尿病组相比显著增高（Ｐ＜０．０５），但观察组与脑梗死组相比无统计学意义（Ｐ＞０．０５）。
结论 糖尿病合并急性脑梗死患者微栓子数目和血清 Ｈｓ－ＣＲＰ、白介素－６水平明显增高，提示糖尿病脑梗死患者血管内炎性斑块不稳定程度增加，再发卒中的风险明显增高。
