低灌注和栓塞的共同作用在缺血性卒中中扮演的角色

Complementary Interaction of Embolism and Hypoperfusion in Ischemic Stroke

传统观点认为低灌注和栓塞是动脉闭塞性病变患者发生卒中的两个互不相干的重要原因。然而,尽管低灌注和栓塞在机制和部位上迥然不同,但在严重阻塞性病变中它们常同时存在,且在狭窄远端的低灌注区域导致栓塞的冲刷障碍。除非侧支血液供应能足以避免缺血的发生,否则在低灌注的脑部区域内将发生多发性的远端点状梗死。在交界区分布的梗死一直被认为是单独由血流动力学障碍所致,但必须要考虑到栓塞形成和低灌注区域之间互补的相互作用,因而低灌注伴随栓塞或单独的栓塞是卒中最常见的原因,而前者所伴随的临床功能缺损往往轻于后者。

Traditionally hypoperfusion and embolism are considered separate important causes of stroke in patients with arterial occlusive disease.However,although hypoperfusion and embolism differ in mechanism and location,they generally co- incide in severe obstructive lesions and cause washout disturbance of embolism in low perfusion territories distal to stenosis.Un- less the collateral blood supply is sufficient to prevent ischemia,multiple remote spot-like infarctions occur within the hypoper- fused brain territory.Border-zone distributed infarction was long suspected to result from hemodynamic disorder alone,but complementary interaction of embolisation and hypoperfusion territories has to be considered.Thus hypoperfusion with embolism or embolism alone is the most common explanation for stroke,the former often associated with less severe clinical deficits than the latter.