TIA进展成脑梗死的脑梗死模式和血管病变特征

Infarct patterns of stroke after TIA and the characteristics of involved vascular lesions

目的分析前循环TIA进展成脑梗死的脑梗死模式和血管病变特征,试探讨其发病机制。方法利用DSA、颈动脉超声和TCD综合定位责任血管狭窄(≥50%)或闭塞及症状侧颈动脉斑块性质,常规MRI研究前循环TIA进展成脑梗死的梗死模式。结果 51例TIA进展成脑梗死患者的MRI脑梗死模式和血管病变特征:皮层下梗死最常见37例(69.8%),其次是分水岭梗死8例(15.1%),区域性梗死5例(9.4%),皮层梗死3例(5.7%)。统计严重血管病变(≥50%狭窄或闭塞)如下:(1)皮层下梗死组血管严重病变17例(45.9%),检出责任侧不稳定斑块6例(16.2%);(2)分水岭梗死组血管严重病变7例(87.5%),检出责任侧不稳定斑块2例(25%);(3)区域性梗死组血管严重病变5例(100%),检出责任侧不稳定斑块2例(40%);(4)皮层梗死血管严重病变3例(100%),检出责任侧不稳定斑块2例(66.7%)。结论前循环TIA进展成脑梗死的梗死类型以皮层下梗死最常见,血流动力学和动脉-动脉栓塞机制均为TIA进展成脑梗死的主要机制。

Objective The lesion patterns of stroke after TIA and the characteristics of involved vascular atherosclerotic changes were analyzed in order to infer to the possible mechanisms of stroke after TIA.Methods All patients underwent the examination of carotid ultrasound and transcranial Doppler,and some performed DSA further.The degree of stenosis of clinically relevant artery and the characteristics of carotid plaques were compared between the two groups.MRI was used to analyze the lesion patterns of stroke after TIA.Results The lesion patterns of stroke after TIA and the characteristics of involved vascular lesions in 51 patients were as follows：the most common one was subcortical infarction in 37 patients （69.8%）,the next was border zone infarction in 8 patients （15.1%）,territory infarction in 5 patients （9.4%）,and cortical infarction in 3 patients （5.7%）.We defined severe artery lesion as ≥50% stenosis or occlusion.（1）Subcortical infarction group：severe stenosis or occlusion was observed in 17 cases （45.9%）,and unstable plaques in focus side were observed in 6 cases （16.2%）.（2）Border zone infarction group：severe stenosis or occlusion was observed in 7 cases （87.5%）,and unstable plaques in focus side were observed in 2 cases （25%）.（3）Territory infarction group：severe stenosis or occlusion was observed in 5 cases （100%）,and unstable plaques in focus side were observed in 2 cases （40%）.（4）Cortical infarction group：severe stenosis or occlusion was observed in 3 cases （100%）,and unstable plaques in focus side were observed in 2 cases （66.7%）.Conlusions The most common pattern of cerebral infarction after TIA was subcortical infarcts.Both hemodynamic compromise and artery-artery embolism may be common mechanism of stroke after TIA.