Praxis Medica (Jan 2019)
Extracranial carotid atherosclerosis in genesis infarction brain in the border zones supratentorial localization
Abstract
Introduction: The emergence of brain infarction depends to a great extent on the status of collateral blood circulation and is associated with hemodynamic instability. This kind of brain infarction is usually found in border vascular zones. Infarction of borderline fields arises between vascular territories ACA and ACM or between ACM and ACP, deep paraventricular infarcts in internal border zones, wound or triangular cortical infarcts, as well as major infarctions involving the entire irrigated territory of ACM. Aim:To define the atherosclerotic stenosis of the inner carotid artery and its significance in brain infarction genes in the borderline of supratentorial localization. Material and methods: Inclusion criteria for inclusion in the study are the existence of an infarct lesion in a predetermined border cortical and subcortical area of supratentorial localization. Data on extracranial atherosclerotic carotid disease were obtained by ultrasonographic inspection of a commercially available apparatus, 7-9 and 9-14 MHz probes/catheter. As a criterion for assessing the degree of carotid stenosis, the formula of the apparatus software was used: 100 x (A - B) / wherein Ais the area of the cross-section of the artery at the site of the largest stenosis, and the B surface of the free lumen artery cross section on the largest stenosis site. Results: The study included 30 selected patients, 12 (40%) females, aged 47-79, (± 62.3 years) and 18 (60%) male, aged 43-79 (± 58.7 years). Cortical infarction of the frontal border region (ACA - ACM) was seen in 11 (36.6%), 15 (50%) ACM - ACP infarct, while subcortical infarction between the surface and deep branches a. Cerebri media ACM - ACM), seen in 4 (13.4%) patients. Carotid atherosclerosis in the form of occlusion or significant stenosis with unilateral localization was observed in 6 (26%) patients, while bilateral changes were present in 17 (74%) patients. In the ACA + ACM group (ACM + ACM), a statistically significant increase in bilateral carotid artery involvement was observed in the group of patients with cerebral infarction of the last ACM-ACP border region (p = 0.018). Conclusion: The two-sided significant steno-occlusive atherosclerotic disease of the inner carotid artery is a very common and statistically significant finding in patients with endocardial infarction of supratentorial localization. This finding corroborates the pathophysiological explanation of this entity and opens up adequate therapeutic perspectives in the prevention and treatment of this kind of stroke.
