皮质下分水岭梗死与颅内外血管狭窄的关系

Relationship between subcortical watershed infarction and extra-intracranial arterial stenosis

目的探究皮质下分水岭梗死(SWI)与颅内外血管狭窄的关系。方法提取南京卒中注册系统中2009年1月—2010年4月,经MRI弥散加权像证实为SWI的25例患者的临床资料,对这些患者均行脑血管造影检查。根据梗死灶的形态,将SWI分为融合型和部分型,分析两种类型梗死与颅内外血管狭窄的关系。结果①25例中,单发SWI有17例(68%);合并同侧皮质型分水岭梗死有8例(32%)。病灶同侧颈内动脉狭窄(狭窄率≥50%)者14例(56%)。其中闭塞性病变2例。大脑中动脉狭窄率≥50%者12例(48%)。12例中,闭塞性病变4例。大脑后动脉狭窄率≥50%者3例(12%)。②25例中,融合型16例(64%),部分型9例(36%),两组患者颈内动脉、大脑中动脉狭窄(狭窄率≥50%)发生率差异无统计学意义(P>0.05)。③颈内动脉和(或)大脑中动脉狭窄合并同侧大脑后动脉狭窄(狭窄率≥50%)在部分型SWI中,发生比例(3/9)高于融合型SWI(0/16),差异有统计学意义(P=0.037)。结论 SWI与颈内动脉和(或)大脑中动脉狭窄密切相关,颈内动脉和(或)大脑中动脉狭窄合并同侧大脑后动脉狭窄,可能与部分型SWI关系更为密切。

Objective To investigate the relationship between subcortical watershed infarction （SWI） and extracranial and intracranial arterial stenosis. Methods The clinical data of 25 consecutive patients with SWI identified by diffusion weighted MRI were abstracted from the Nanjing Stroke Register System from January 2009 to April 2010. All patients were underwent cerebral angiography. The patients with SWI were divided into partial type and confluent type according to the infarct morphology. The relationship between the two types of infarction and extracranial and intracranial arterial stenosis was analyzed. Results （1）Of the 25 patients, 17 （68%） with SWI alone; 8 （32%） were complicated with ipsilateral cortical watershed infarc- tion ; 14 （ 56% ） had ipsilateral internal carotid stenosis （ stenosis ≥ 50% ）, among them 2 were occlusive lesions; 12 （48%） had middle cerebral artery stenosis （ ≥50% ）, in which 4 were occlusive lesions; 3（12% ） had posterior cerebral artery stenosis ≥ 50%. （2）Of the 25 patients, 16 （64%） were confluent type and 9（36% ） were partial type. There were no significant difference in the incidence of internal carotid artery and middle cerebral artery stenosis （ stenosis ≥ 50% ） between the two groups （ P 〉 0. 05 ）. （3）The incidence of carotid artery and/or middle cerebral artery complicated with ipsilateral posterior cerebral artery stenosis （stenosis ≥ 50% ） in the partial type SWI （3/9） was higher than confluent type SWI （0/16）. There was significant differenee（P = 0. 037）. Conclusion SWI is closely associated with internal carotid arteries and/or middle cerebral artery stenosis. Internal carotid artery and/or middle cerebral artery stenosis complicated with ipsilateral posterior cerebral artery stenosis may be more closely associated with partial type SWI.