进展性脑卒中与颅内外血管病变的相关性

目的探讨症状相关侧颅内外血管狭窄程度、斑块性质与进展性脑卒中的相关性。方法将496例急性缺血性脑卒中患者分为进展性脑卒中组(进展组,120例)和非进展性脑卒中组(非进展组,376例)。采用彩色多普勒超声仪和经颅彩色多普勒超声进行检查,比较2组患者症状相关侧血管狭窄程度、斑块性质的差异。结果24.2%的患者为进展性脑卒中。症状相关侧颅内外血管中、重度狭窄,进展组为79.2%,非进展组为55.1%,2组比较差异有统计学意义(x~2=24.97,P0.01)。症状相关侧颈动脉斑块性质与脑卒中进展无相关性(x~2=2.97,P0.05)。结论进展性脑卒中的发生与症状相关侧颅内外血管狭窄程度(≥50%)密切相关,其发病机制可能与狭窄所致的低灌注有关。

The relationship between progressive stroke and intracranial or extacranial artery lesions

Objective To study the relationship between intracranial or extacranial artery lesions and progressive ischemic stroke.Methods 496 consecutive patients suffering from acute ischemic stroke attributed to lesions of carotid territory were admitted to neurology department of the First Affiliated Hospital of Nanhua university from January 1,2006 to December 30,2008.All patients underwent the examination of carotid ultrasound and transcranial Doppler ultrasonography.The degree of stenosis of clinically relevant artery and the characteristics of carotid plaques were compared between patients with and without progressive ischemia stroke.Results Of all the 496 patients with ischemic stroke,120 patients(24.2%) had progressive stroke during acute phase. Ninety-five(79.2%) of the 120 patients with progressive stroke suffered from intracranial or extacranial artery stenosis,207(55.1%) of 376 patients with non-progressive stroke suffered from intracranial or extracranial artery stenosis.A significant stenosis of clinically relevant artery (≥ 50%) was demonstrated more frequently in the progressive stroke group(79.2%) than in the non-progressive stroke group(55.1 % ,x~2 = 24.97,P < 0.01).No significant correlation was observed between the progressive stroke and characteristics of carotid plaques in the focus side (x~2 =2.97,P > 0.05).Conclusion There is close relationship between ≥50% stenosis of clinically relevant artery and occurrence of progressive ischemic stroke.Low cerebral blood flow due to hemodynamic compromise may be an important mechanism in stroke evolution.