不同类型内分水岭梗死与颈内动脉串联狭窄的关系

目的探讨不同类型内分水岭梗死与颈内动脉(ICA)串联狭窄的关系。方法回顾性连续纳入55例经头部MRI+扩散加权成像(DWI)检查证实为内分水岭梗死患者,均行颅外段ICA彩色多普勒超声和颅内血管MR血管成像检查。根据影像学检查结果,将55例内分水岭梗死患者分为单发内分水岭梗死(IWSI)组和伴有同侧皮质分水岭梗死的内分水岭梗死(C-IWSI)组,分析两种类型内分水岭梗死与ICA串联狭窄的关系。结果 (1)55例内分水岭梗死中,包括IWSI组24例(43.6%),C-IWSI组31例(56.4%)。病灶侧血管狭窄:ICA 20例(36.4%,其中颅外段11例,颅内段17例),大脑中动脉(MCA)44例(80.0%),ICA串联狭窄15例(27.3%)。(2)病灶侧ICA串联狭窄:IWSI组2例(颅内段ICA+MCA 2例);C-IWSI组13例(颅外段ICA+颅内段ICA+MCA 4例,颅外段ICA+颅内段ICA 1例,颅外段ICA+MCA 2例,颅内段ICA+MCA6例)。(3)与IWSI组相比,C-IWSI组患者病灶侧ICA狭窄、ICA串联狭窄发生率均较高[分别为54.8%(17例)比12.5%(3例),41.9%(13例)比8.3%(2例)],差异均有统计学意义(P值分别为0.001和0.006),其中颅外段和颅内段ICA狭窄发生率均高于IWSI组[35.5%(11例)比0,45.2%(14例)比12.5%(3例)],差异均有统计学意义(P值分别为0.003和0.009)。结论不同类型内分水岭梗死ICA串联狭窄发生率不同,伴有同侧皮质分水岭梗死的内分水岭梗死患者,常伴有颈内动脉串联狭窄。

Relationship between different types of internal watershed infarction and tandem stenoses of the internal carotid artery

Objective To investigate the relationship between different types of internal watershed infarction and tandem stenoses of internal carotid artery （ ICA ）. Methods A total of 55 patients with internal watershed infarction confirmed by head MRI and diffusion-weighted imaging （ DWI ） examination were enrolled. They all underwent the extraeranial internal carotid artery （ ICA ） uhrasonography and intracranial cerebral artery MR angiography （MRA） examinations. According to the findings of imaging, the 55 patients with internal watershed infarction were divided into a simple internal watershed infarction （IWSI） group and an internal watershed infarction accompanied with ipsilateral cortical watershed infarction （C-IWSI） group. The relationship between the two types of internal watershed infarction and tandem stenoses of ICA was analyzed. Results （1） Of the 55 patients with internal watershed infarction,24 cases （43.6%） were in the internal watershed infarction group and 31 cases （56.4%） were in the C-IWSI group. The ipsilateral vascular stenosis were ICA 20 cases （ 36.4% , including extracranial segment 11 cases and intracranial segment 17 cases）,middle cerebral artery （MCA） 44 cases （80.0%）,and tandem stenoses of ICA 15 cases （27.3%）. （2） Ipsilateral tandem stenoses of ICA：2 cases were in the IWSI group （intracranial ICA ＋ MCA 2 cases） ;13 cases were in the C-IWSI group （extracranial ICA ＋ intracranial ICA ＋ MCA 4 cases, extracranial ICA ＋ intracranial ICA 1 case, extracranial ICA ＋ MCA 2 cases, and intracranial ICA ＋ MCA 6 cases）. （3） Compared with the IWSI group, the incidences of ipsilateral ICA stenosis and tandem stenoses of ICA in patients of the C-IWSI group were higher （54.8% [ n = 17 ] vs. 12.5% [ n = 3 ] ,41.9% [ n = 13 ] vs. 8.3% [ n = 2 ] ）, and there were significant differences （P = 0. 001, 0. 006] ）. The incidences of extracranial and intercranial ICA stenosis were higher than those of the IWSI group （35.5% [ n =