大脑中动脉供血区梗死灶形态与可能发病机制的回顾性研究

目的 探索大脑中动脉(MCA)供血区的梗死灶形态与脑卒中可能发病机制之间的关系.方法 回顾性分析了148例连续的急性缺血性脑卒中患者,所有患者均为颈内动脉(ICA)系统脑梗死,DWI显示相应MCA供血区责任病灶,根据血管及心脏检查将患者分为ICA病变组、MCA病变组、ICA+MCA病变组、心源性栓塞组(CE组)及检查结果阴性组(NR组).将梗死灶形态分为单发和多发,前者按部位分为:穿动脉梗死灶(PAI)、皮质支梗死灶(PI)、分水岭梗死灶(BZ)、大面积梗死灶.结果 MCA供血区的梗死灶形态可分为12种;不同病变所致脑卒中的梗死灶形态存在差异(χ2=55.88,P=0.004).但在MCA组、ICA组、MCA+ICA组及CE组中,未发现各自特异的梗死灶形态,仅PAI更多见于MCA组;与NR组相比,ICA组患者中更多出现PAI伴PI(7/27,χ2=6.61,P<0.05),而MCA组和CE组均未见特征性的梗死灶形态.动脉狭窄的程度与梗死灶形态亦存在一定关联,重度ICA病变更多地表现为PAl伴PI(5/16,χ2=7.32,P<0.05);而重度MCA病变则好发PAI伴BZ(4/30,χ2=5.59,P<0.05)及PAI伴PI和BZ(6/30,χ2=6.41,P<0.05).结论 MCA供血区内的梗死灶形态与其颅内动脉病变之间存在一定的关系,揭示脑卒中发生的不同机制,可能与动脉-动脉栓塞、灌注不良有关;我们以检查结果阴性患者为对照比较,尚不能完全揭示MCA供血区内的梗死灶形态和与脑卒中的不同机制之间的相关性.

Retrospective study of stroke mechanism and lesion patterns in middle cerebral artery territory

Objective To identify lesion patterns and stroke mechanisms in middle cerebral artery (MCA) territory using early diffusion-weighted imaging (DWI) combined with CTA as well as EKG and echocardiography.Methods One hundred and forty-eight acute ischemic stroke patients who had (1) symptomatic lesions located in the unilateral MCA territory on DWI performed within 1 week of symptom onset,and (2) either corresponding MCA disease,internal carotid artery (ICA) disease,MCA & ICA disease or cardio embolism (CE),or (3) neither corresponding MCA disease,ICA disease,nor CE which were taken as group of negative results (NR),were reviewed.Acute DWI lesion patterns were classified as (1) single (small perforator < 2 cm;large perforator ≥2 cm;pial;large territorial;border-zone) and (2) multiple according to principle of single-blind.Results There were 12 types of lesions in MCA territory.Distribution of lesion patterns in different stroke subtypes might be different (χ2= 55.88,P = 0.004).No specific pattern could be found in patients with MCA disease,ICA disease,MCA & ICA disease or CE.Big perforator infarcts might be more common in patients with MCA disease than with ICA disease and CE.Compared with negative group,concomitant perforator and pial infarcts were more common in patients with ICA disease (7/27,χ2=6.61,P <0.05),especially with severe stenosis or occlusion (5/16,χ2=7.32,P < 0.05);No specific pattern could be found in patients with MCA disease or CE.Concomitant perforator,pial,with border-zone infarcts (6/30,χ2= 6.41,P <0.05),and concomitant perforator with border-zone infarcts (4/30,χ2= 5.59,P < 0.05) were more often in patients with severe stenosis or occlusion of MCA.Conclusion Different lesion patterns may indicate different mechanisms of stroke such as hypoperfusion and arterial embolism could be coexistent in MCA territory.The relationship has not been identified perfectly.