<International Circulation>: You have given a lecture about the latest development of cerebral amyloid angiopathy (CAA)， could you please introduce the key message?
Prof. Charlotte Cordonnier: We all know that CAA is a haemorrhagic disease but we have to take into account that sometimes due to the progressive occlusion of the small vessels with the amyloid deposition there is an occlusion aspect to the disease also. We should keep in mind that besides lobar haemorrhage or lobular microbleed there is an occlusion expression of white matter lesions and with small cortical infarcts. Those small cortical lesions can sometimes explain the focal symptoms that patients with CAA stroke often describe. Secondly， we probably under investigate patients who have a lobar ICH， because in a seventy year old patient without high blood pressure and with lobar ICH most people will perform a CT scan and draw conclusions from that it is amyloid angiopathy. From this they will not search for anything else and we should keep in mind there are other diseases which can lead to a lobar ICH. The third part of my talk focused on the therapeutic avenues we should take， which centred on prevention. If you are presented with a patient who you suspect has CAA then you should withdraw anticoagulants. This even in the case of atrial fibrillation where anti platelets are also preferred. You should treat the high blood pressure because secondary analysis of the PROGRESS Trial suggests that lobular ICH probably due to CAA is an excellent target for reducing blood pressure. It is an excellent target for preventing lobular bleeding. There was also another question regarding statins where according to new mathematical models we should withdraw statins in patients with a lobular ICH.
<International Circulation>: CAA can be found usually in elderly patients who have lobar recurrent haemorrhage without hypertension. Is hypertension， another important reason of cerebral haemorrhage and does it have any effect on patients with cerebral amyloid angiopathy?
Prof. Charlotte Cordonnier: The problem with hypertension is that it is very frequent in ICH cohorts whereby 60% are hypertensive. High blood pressure is probably more frequent in ICH than it is for deep ICH. Amyloid angiopathy is very frequent in autopsies in healthy people so that this in itself is not sufficient to provoke a bleed. Maybe a co-factor could be high blood pressure. High blood pressure on very small cortical vessels which are already fragilized due to the amyloid deposition could bleed more easily or maybe it is due to angiopathy plus high blood pressure anti-thrombotic treatment. We do not know yet how all these factors co-exist.
<International Circulation>: Autopsy is considered the gold standard of diagnosis， is there any better method can help us to confirm the existence of CAA?
Prof. Charlotte Cordonnier: Most doctors think that just with imaging you can detect CAA but the problem with this disease is that we do not have strong validated diagnostic criteria that we can apply in vivo. Therefore， only autopsy can really define the diagnosis. If we want to develop new diagnostic techniques we will have to validate them against the gold standard which remains autopsy.
演讲重点
首先，脑淀粉样血管病（CAA）是一种出血性疾病，但是淀粉样物质在小血管内沉积造成的阻塞也是脑淀粉样血管病变的一部分。除了脑叶出血或脑小叶微出血，CAA患者可能还有白质病变和小的皮质梗塞。这些小的皮质损伤有时可以解释脑淀粉样血管病卒中患者常出现的局灶症状。其次，我们对脑叶自发性出血患者的检查可能是不足的，当一位70岁的无高血压病史的老年患者出现自发性脑叶出血时，大部分医生会行CT检查，并得出脑淀粉样血管病的结论，且不再做一步探究。但是，我们应该想到还有其他疾病会导致脑叶的自发性出血。第三，重在预防。如果碰到一个怀疑是脑淀粉样血管病的患者，应停用抗凝药，推荐使用抗血小板药物的心房颤动患者也应停药。PROGRESS试验的二级分析表明，预防脑小叶出血是降低血压的重要目的，所以对于高血压患者应予以降压治疗，也可防止脑小叶的继续出血。此外，最新的统计分析模型显示，发生脑小叶出血的患者时应停用他汀药物。
CAA与高血压的关系
高血压是CAA患者出血的一个危险因素，但并不是本病的病因。脑淀粉样血管病多发生在有反复脑叶出血且不伴有高血压的老 年人。高血压是脑出血的另一个常见原因。自发性出血的患者中60%处于高血压状态。相比深部出血，高血压在脑叶出血患者中更为常见。健康个体尸检常发现CAA，可见它本身是不足以引起出血的。高血压是CAA的联合作用因素。高血压作用于已有淀粉样物质沉积的脆弱的小皮质血管上会极易引发出血，血管病变加上高血压的双重抗血栓治疗也可能导致出血。目前我们仍不清楚这些因子是如何互相作用的。
诊断标准
尸检被认为是CAA诊断的金标准，但是大部分医生都认为仅通过影像学检查就可以发现CAA，只是我们没有能够应用于活体的有效的诊断标准。所以，目前还是只有尸检可以明确诊断。