颈内动脉系统脑梗死责任血管自发性再通的MRA研究

Spontaneous recanalization of responsible vessels on MRA in infarction of internal carotid artery system

目的探讨颈内动脉系统脑梗死责任血管自发性再通发生率、发生时间、梗死模式以及再通机制。方法回顾性收集了2015年5月—2016年5月共441例就诊于天津医科大学总医院的脑梗死病例,其中男279例,女162例,年龄31~90岁,平均(63.17±10.10)岁。所有脑梗死病人均进行了常规MRI、DWI及MRA检查。依据MRA上显示梗死灶责任血管有无狭窄将全组病人分为再通组和非再通组。2组间病人年龄、自发病初至MRA检查时间差异的比较采用双样本t检验,病人性别、病变侧别及其他临床资料的组间比较采用χ2检验。结果 441例病人中有300例(68.03%,男192例,女108例)存在责任血管狭窄或闭塞,为非再通组;141例(31.97%,男87例,女54例)未见责任血管狭窄或闭塞,为再通组。脑梗死后血管自发性再通的发生率为31.97%。2组间病人年龄、性别、病变侧别及其他临床资料的差异均无统计学意义(均P>0.05)。再通组的自发病至MRA检查时间明显小于非再通组(P=0.002)。2组病人中单一梗死模式均较混合梗死模式多见,其中穿支动脉供血区梗死模式最多见。再通组病人3 d内再通比例为90.07%,3~7 d再通比例为9.93%。结论闭塞血管自发性再通率约为30%,再通多发生在脑梗死前3 d内,再通比例达90.07%,终末支小血管再通率高。了解脑梗死后脑血管自发性再通有助于避免过激治疗。

Objective To investigate spontaneous recanalization rate, course, infarct pattern, and recanalization mechanism of responsible artery in patients with acute stroke. Methods We conducted a retrospective review of 441 patients（male/female, 279/162; age 31-90 years, mean age 63.17±10.10 years） with acute stroke in the territory of the internal carotid artery（ICA） system from May 2015 to May 2016 in Tianjin Medical University General Hospital. All patients with cerebral infarction undergo routine MRI, DWI and MRA examinations.According to the MRA showed whether there is any stenosis or not in the infarct responsibility vessel, the whole patients are divided into recanalization group and non recanalization group. The differences in age and time interval from the onset to the MRA examination were compared with the two sample t test between the 2 groups, and the patient＇s gender, lesion side, and other clinical data were compared with chi square test. Results There were 300 of 441 patients（68.03%, male 192 and female 108） with responsible arterial stenosis or occlusion, which were classified into recanalization group, whereas 141 patients（31.97%, male 87 and female 54） without responsible arterial stenosis or occlusion were classified into non recanalization group. The rate of spontaneous recanalization was31.97%. There was no significant difference between the two groups in terms of age, sex, lesion side, and other clinical data（all P〈0.05）. The time interval from onset to MRA in the recanalization group was significantly shorter than that in the nonrecanalization group（P=0.002）. Most patients of both groups had single infarction, and the most common pattern was perforating artery infarction. The recanalization ratio within 3 days was 90.07% in the recanalization group, and within 3-7 days the recanalization ratio was 9.93%. Conclusion The incidence of early spontaneous recanalization is about 30%. Spontaneous recanalization usually occurs approximately within the first 3 days. The recanalization rate is 90.07%. The spontaneous recanalization of small terminal arteries is high. Understanding the spontaneous recanalization after cerebral infarction may help clinicians to avoid aggressive treatment.