分水岭脑梗死的类型与颈内动脉及大脑中动脉狭窄的关系

目的 探讨分水岭脑梗死的类型与颈内动脉、大脑中动脉狭窄的关系.方法 收集我科收治的70例行CT血管造影（computerized tomography angiography,CTA）及头部磁共振弥散加权成像的分水岭脑梗死患者,根据核磁共振弥散成像（DWI）的形态学特征对梗死形态进行分型,分为皮质型（皮质前型、皮质后型）、皮质下型及混合型,分别比较不同类型分水岭脑梗死患者的颈内动脉、大脑中动脉病变情况.结果 （1）70例患者中皮质型梗死12例,其中皮质前型8例,皮质后型4例;皮质下型36例,混合型22例;（2）CTA显示颈内动脉或（和）大脑中动脉的中重度狭窄或闭塞的共有51例,占72.9％ （51/70）,其中皮质型血管病变发生率66.7％（8/12）,以大脑中动脉比率最高,占50％（6/12）,颈内动脉、颈内动脉＋大脑中动脉串联病变各占8.3％（1/12）,大脑中动脉病变率与颈内动脉及串联病变比较,差异有统计学意义;皮质下型血管病变率86.1％（31/36）,大脑中动脉、颈内动脉及串联病变分别占44.4％ （16/36）、22.2％ （8/36）、19.4％（7/36）;而混合型血管病变率54.5％ （12/22）,颈内动脉病变比例较高,占31.8％（7/22）,大脑中动脉22.7％（5/22）.结论 分水岭脑梗死患者多存在大脑中动脉和颈内动脉的重度狭窄或闭塞,大脑中动脉粥样硬化性中重度狭窄或闭塞是皮质型分水岭脑梗死的主要病因之一.

The Subtype of Watershed Infarction and the Internalcarotid Artery/middle Cerebral Artery Steno-occlusion

Objective To analyze the relationship between watershed infarction and occlusive diseases of internal carotid artery/middle cerebral artery and to identify the pathogenesis of watershed infarction. Methods We identified 70 watershed infarction patients with diffusion - weighted magnetic resonance imaging by com- monly used templates. Steno - occlusion of carotid arteries and middle cerebral artery were assessed by CT an-giography. Results 12 patients had cortical watershed （CWS） infarction, and 36 patients had internal watershed（ IWS） infarction. 8 patients in CWS group had anterior watershed infarction and 4 patients had posterior watershed infarction. 22 patients had mixed watershed infarction （combined with other infarct pattern）. 51 patients had severe stenosis （〉50 % ） or occlusion in either the internal carotid artery （ICA） or/and middle cere- bral artery （MCA）. stenotic - occlusive diseases of MCA were more prevalent in CWS group. Conclusions There is a relatively definite relationship between watershed infarction and stenotic - occlusive diseases of internal carotid arteries and middle cerebral artery, which is the major pathogenesis of watershed infarction.