Zhongguo cuzhong zazhi (Apr 2018)
不同病因分型的穿支动脉供血区梗死患者的临床及影像学研究 Study on Clinical and Imageology Characteristics of Different Etiology Types of Patients with Penetrating Artery Territory Infarction
Abstract
目的 利用高分辨率磁共振成像诊断穿支动脉疾病及载体动脉斑块堵塞穿支动脉的大动脉粥样硬 化型卒中，比较不同病因穿支动脉供血区梗死患者的临床特征。 方法 收录豆纹动脉及脑桥旁正中动脉供血区急性脑梗死患者作为研究对象，依据中国缺血性卒中 分型诊断（Chinese Ischemic Stroke Subclassification，CISS）分型标准排除心源性、其他病因及原因未明 性卒中，对所有入组患者的载体动脉行高分辨率磁共振管壁成像（high-resolution magnetic resonance i magi ng，HR -MRI）检查，将载体动脉存在粥样硬化斑块患者定义为载体动脉斑块堵塞穿支动脉 （parent artery plaque occluding penetrating artery，POPA）组，载体动脉无异常者定义为穿支动脉疾病 （penetration artery disease，PAD）组，比较不同病因卒中患者的危险因素及临床特征。 结果 本研究共连续纳入64例穿支动脉供血区急性脑梗死患者，其中48例（75%）为POPA患者，且 其中21例患者常规血管影像学检查难以发现载体动脉管壁病变，经HR -MRI 明确诊断。比较两组 不同病因卒中患者的一般资料，POPA组中吸烟患者比例显著高于PAD组，比较差异有统计学意义 （P =0.028）。POPA组中26例为基底节区或侧脑室旁梗死，22例为脑桥梗死。POPA组患者影像学表现 特点为病灶相对较大、呈多灶或簇状分布，脑桥梗死患者病灶多累及脑桥基底部呈脑桥旁正中梗死， 且POPA组患者运动功能缺损易进展；而PAD患者病变部位多位于脑桥深部近背侧，小灶性改变。 结论 本研究穿支动脉供血区梗死患者中75%属于POPA，HR-MRI提高了卒中病因分型的准确性。 POPA型卒中患者的病因、病灶体积、形态及预后不同于单纯穿支病变患者。 Abstract: Objective High-resolution magnetic resonance imaging (HR-MRI) was used to diagnose penetrating artery territory infarction ,including penetrating artery disease (PAD) and parent artery plaque occluding penetrating artery (POPA), which belongs to the large-artery atherosclerosis, and clinical features of two groups were compared. Methods Patients with acute striate artery and pontine paramedian artery territory infarction were enrolled as study subjects. According to the criteria of Chinese Ischemic Stroke Subclassification (CISS), cardiogenic stroke, other etiologies and undetermined etiology were excluded. The patients who were eligible for the criteria were examined by high-resolution magnetic resonance imaging (HR-MRI) to evaluate atherosclerosis of the parent artery. Patients with atherosclerotic plaque in the parent arteries were defined as the POPA group, and those without abnormalities were defined as the PAD group. The risk factors and clinical characteristics of the two groups were compared. Results A total of 64 patients with penetrating artery territory infarction were enrolled in this study. POPA was diagnosed in 75.0% of patients, among which, 43.7% patients whose magnetic resonance angiography/transcranial Doppler were normal, while HR-MRI detected the parent arteries with plaques. The general data of two groups were compared. Patients with POPA had a higher frequency of smoking compared with that of the patients with PAD (P =0.028). There were 26 patients in POPA group with striate artery territory infarction and 22 patients with pontine paramedian artery territory infarction. Compared with infarct lesions with PAD, ischemic lesions in POPA patients were relatively larger, shown as multifocal or cluster-like distribution and frequently extended to the surface of the pons base. And neurological deficits was easily to progress. While lesions with PAD were usually small lacunar infarctions or located in the deep of pons. Conclusion In this research, 75.0% of the penetrating artery territory infarction belongs to parent artery atherosclerosis, and HR-MRI has the ability to improve the accuracy of clearing the etiology of ischemic stroke. The risk factors, clinical characteristics and radiological features of POPA patients were different from PAD.
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