单侧颈内动脉狭窄或闭塞的影像学梗死类型及脑血流动力学评价

目的研究单侧动脉粥样硬化性颈内动脉狭窄或闭塞(ICASO)性脑梗死患者影像学梗死类型及其脑血流动力学改变,以探讨脑梗死发生的可能机制。方法 87例经脑血管造影明确诊断的单侧动脉粥样硬化性ICASO性脑梗死患者,MRI和TCD检查分析影像学梗死类型及不同类型之间存在的脑血流动力学差异。结果 MRI所见脑梗死类型共分为区域梗死(30例,34.48%)、皮质下梗死(27例,31.03%)、边缘带梗死(18例,20.69%)和弥散小梗死(12例,13.79%),不同脑梗死类型发生率之间差异具有统计学意义(χ~2=7.156,P=0.028);脑梗死类型与颈内动脉狭窄程度呈负相关(r=-0.275,P=0.010),重度狭窄以皮质下梗死、边缘带梗死多见(均11/36,30.56%),完全闭塞则以区域梗死常见(17/34,50.00%)。脑血流动力学观察显示,不同脑梗死类型患侧大脑中动脉平均血流速度和搏动指数与健侧存在明显的不对称性(均P=0.000),其中以区域梗死最低,次之为边缘带梗死。结论 ICASO以区域梗死多见,且脑血流动力学障碍存在于各种脑梗死类型中。提示应综合考虑脑梗死类型和脑血流动力学改变,从而选择恰当的防治方法。

Evaluation of stroke topographic patterns and intracerebral hemodynamics in unilateral internal carotid artery stenosis or occlusion

Objective To study the pathogenesis of cerebrovascular disorders by analysing the categories of cerebral infarct on magnetic resonance imaging(MRI) and intracerebral hemodynamics of patients with unilateral atherosclerotic internal carotid artery stenosis or occlusion(ICASO).Methods From August 2007 to May 2009,87 ischemic stroke patients who were diagnosed arteriosclerosis ICASO by cerebral arteriography were investigated in Department of Neurology,the First Teaching Hospital of Xinjiang Medical University.Patients with potential cardiac sources of embolism were excluded.Cerebral infarct patterns were detected by MRI and the difference in cerebral hemodynamics were analysed by transcranial Doppler(TCD) among different imaging patterns.Results The infarct patterns in 87 patients were divided into 4 groups:territory infarcts(n = 30,34.48%),subcortical infarcts(n = 27,31.03%),borderzone infarcts(n = 18,20.69%),and disseminated small infarcts(n = 12,13.79%).The distribution ratio of topographic patterns was significant in different degree of ICASO(x~2 = 7.156,P = 0.028).The topographic pattern was negatively correlated with the degree of ICASO(r = -0.275,P = 0.010).Serious internal carotid artery(ICA) stenosis was associated with subcortical infarcts,border-zone infarcts(11/36,30.56%,for all); territory infarcts showed a strong trend to appear mostly in patients with total ICA occulation(17/34, 50.00%).Seventy-five cases were involved in the hemodynamics analysis.In different groups of patient the mean flow velocity(Vm) and blood vessel pulsatility index(PI) of the affected side were all significantly lower than those of the intact side,while the lowest was shown in territory infarcts,and then in border-zone infarcts(P=0.000,for all).Conclusion ICASO is mostly seen in patients with territory infarct,and hemodynamic disorder may.occur in all infarct patterns.Therefore,cerebral infarct patterns and hemodynamic changes should be adequately considered for selecting optimal therapeutic and preventive measures.