颈内动脉系统狭窄或闭塞脑梗死患者病灶影像学特征

Lesion patterns of internal carotid artery stenosis or occlusion on CT angiography in patients with acute ischemic cerebral infarction

目的探讨颈内动脉(ICA)系统狭窄或闭塞急性缺血性脑梗死(AICI)患者影像学病灶特点。方法 71例急性脑梗死患者,CT血管成像检查证实存在颈内动脉(ICA组,47例)或大脑中动脉(MCA组,24例)狭窄或闭塞,比较两组梗死病灶影像学特征。结果病灶模式包括弥散小梗死、皮质下梗死、分水岭梗死和区域性梗死四种。其中,ICA组分水岭梗死发生率高于MCA组(40.4%vs.12.5%)(P<0.05),皮质下梗死发生率低于MCA组(19.1%vs.50.0%)(P<0.05)。结论 ICA狭窄或闭塞性AICI患者以分水岭梗死多见,提示其发病机制可能以动脉-动脉栓塞合并低灌注-栓子清除能力下降为主;MCA狭窄或闭塞患者皮质下梗死较多见,提示其发病机制可能以动脉-动脉栓塞合并局部穿支闭塞为主。

Objective To analyze the lesion patterns of internal carotid artery（ICA） stenosis or occlusion on CT angiography （CTA） in patients with acute ischemic cerebral infarction（AICI）. Methods Confirmed by CTA, 71 AICI patients were assigned into two groups of ICA（47 cases） and MCA（middle cerebral artery, 24 cases）. The image characteristics of four lesion patterns of territory infarcts, subcortical infarcts, border zone infarcts and several disseminated small infarcts were compared. Results Of four lesion patterns, the incidence rate of border zone infarcts was higher, but that of subcortical infarcts was lower, in group ICA than those in group MCA（40.4% vs. 12. 5%, 19.1% vs. 50. 0%） （P〈0. 05）. Conclusion Territory infarcts are seen more in AICI patients with ICA stenosis or occlusion, suggesting that the underlying mechanism is more likely related to the artery-artery embolism combined with hypoperfusion-impaired clearance of embolL Subcortical infarcts are seen more in MCA stenotic or occlusive patients, suggesting that the underlying mechanism is more likely related to the artery-artery embolism combined with occlusion of the local branch.