颈内和大脑中动脉狭窄与闭塞的梗死类型及卒中机制的研究

Lesion patterns and stroke mechanism in patients with internal carotid artery/middle erebral artery stenosis or occlusion

目的研究单侧动脉粥样硬化性MCA/ICA狭窄与闭塞的急性缺血性脑卒中患者在DWI上的梗死类型及发病机制。方法起病48h内DWI诊断的急性脑梗死伴有动脉粥样硬化性MCA/ICA狭窄与闭塞的131例患者,有潜在心源性栓子患者除外。急性期DWI上梗死病灶分为:(1)单发病灶(小的穿动脉梗死灶;大的穿动脉梗死灶,皮层支梗死,大面积梗死,分水岭梗死);(2)多发梗死病灶。结果131例患者,ICA51例,MCA80例。ICA出现最多的梗死类型:穿支动脉伴分水岭梗死,但与MCA比较,皮层支伴分水岭梗死具有统计学意义(8/51,P=0.001)。MCA以穿支动脉伴皮层支梗死最多,且与ICA比较,具有统计学意义(12/80,P=0.003)。MCA中任何皮层支梗死与狭窄程度无关,ICA中任何分水岭梗死与狭窄程度相关。结论颈内和大脑中动脉狭窄与闭塞在DWI上的梗死类型有明显的不同,提示有着不同的卒中发病机制。

Objective To investigate lesion patterns on DWI and stroke mechanism in acute cerebral ischemic stroke patients with internal carotid artery/middle erebral artery stenosis or occlusion. Methods We diagnosed 131 acute ischemic stroke patients by DWI within 48 hours of symptom onset and who had internal carotid artery/ middle cerebral artery stenosis or occlusion. Patients with potential cardiac sources of embolism were excluded. Acute DWI lesion patterns were classified as single （small perforator 〈1.5 cm;large perforator 1.5 cm;pial;large territorial;border-zone） and multiple one. Results There were 80 of 131 patients with MCA disease and 51 of 131 patients with ICA disease. Concomitant perforator and border-zone infarcts were most in patients with ICA. But Concomitant pial and border-zone infarcts （8/51 ,P= 0. 001） were identified more often in patients with ICA disease than in those with MCA. Concomitant perforator and pial infarcts （12/80,P = 0. 001 ） were identified more often in patients with MCA disease than in those with ICA. No matter they occurred singly or in addition to other lesions,any border-zone infarcts was more frequently observed in patients with severe stenosis or occlusion of ICA. However there was no correlation between the degree of MCA stenosis and any pial pattern. Conclusion Lesion patterns on DWI are distinctively different between atherosclerotic MCA and ICA disease,suggesting different underlying pathogenesis.