远端与近端大脑中动脉闭塞：不同的机制,Cerebrovascular Diseases

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远端与近端大脑中动脉闭塞：不同的机制
Cerebrovascular Diseases ( IF 2.2 ) Pub Date : 2019-01-01 , DOI: 10.1159/000500947
Young Seo Kim ₁ , Bum Joon Kim ₂ , Kyung Chul Noh ₃ , Kyung Mi Lee ₄ , Sung Hyuk Heo ₃ , Hye-Yeon Choi ₅ , Hyun Young Kim ₁ , Seong-Ho Koh ₆ , Dae-Il Chang ₃

Affiliation

背景：大脑中动脉（MCA）梗塞的临床和放射学特征可能因闭塞位置而异。目的：我们研究了缺血性卒中患者近端和远端症状性 MCA 闭塞 (MCAO) 之间的差异。还分析了与成像特性相关的因素。方法：连续入组因 MCAO 引起的缺血性卒中患者。MCAO 的位置由同侧 MCA 的长度与对侧 MCA 的长度之比确定，并分为近端和远端 MCAO。比较近端和远端 MCAO 患者的临床和放射学特征。与基底节 (BG) 受累、出血性转化 (HT)、和入院期间的神经系统变化进行了调查。结果：在纳入的 181 名患者中，MCAO 位置显示出双峰峰（在近端 [n = 99] 和远端 MCA [n = 82]）。近端 MCAO 更常与高脂血症和大动脉粥样硬化相关，而远端 MCAO 更常与高血压、心房颤动和心源性卒中相关。两组之间的 BG 受累情况相似（48 对 39%；p = 0.21），而 HT 在远端 MCAO 中更常见（10 对 23%；p = 0.02）。在近端 MCAO 患者中，有 BG 受累的患者中观察到高信号血管征的频率低于无 BG 受累的患者（38% vs. 60%；p = 0.03）。在没有 BG 受累的患者中，HT 的存在非常低，并且在具有近端和远端 MCAO 的患者之间相似（1.9% 对 2.0%）。然而，在 BG 受累的患者中，远端 MCAO 患者比近端 MCAO 患者更常观察到 HT（54.8% vs. 15.7%；p < 0.001）。高信号血管征（OR 0.172，95% CI 0.051–0.586；p = 0.005）和远端 MCAO（OR 0.200，95% CI 0.059–0.683；p = 0.011）与入院期间的改善独立相关。结论：近端 MCAO 更常与动脉粥样硬化相关，而远端 MCAO 更常与心脏栓塞相关。在近端 MCAO 中，高信号血管征呈现的侧支血流状态可能会影响 BG 的受累。在远端 MCAO 中，首先撞击近端 MCA 导致 BG 缺血的栓子的远端迁移可以解释再灌注损伤导致的高 HT 率。

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Distal versus Proximal Middle Cerebral Artery Occlusion: Different Mechanisms

Background: Clinical and radiological characteristics of middle cerebral artery (MCA) infarction may differ according to the location of occlusion. Objectives: We investigated the difference between proximal and distal symptomatic MCA occlusion (MCAO) in patients with ischemic stroke. The factors associated with the imaging characteristics were also analyzed. Methods: Patients with ischemic stroke due to MCAO were consecutively enrolled. The location of MCAO was determined by the ratio of the length of the ipsilesional MCA to that of the contralateral MCA and dichotomized to proximal and distal MCAO. Clinical and radiological characteristics were compared between patients with proximal and distal MCAO. Factors associated with the basal ganglia (BG) involvement, hemorrhagic transformation (HT), and neurological change during admission were investigated. Results: Among 181 included patients, MCAO location showed a bimodal peak (at the proximal [n = 99] and distal MCA [n = 82]). Proximal MCAO was more frequently associated with hyperlipidemia and large artery atherosclerosis, whereas distal MCAO was more frequently associated with hypertension, atrial fibrillation, and cardioembolic stroke. BG involvement was similar between the 2 groups (48 vs. 39%; p = 0.21), whereas HT was more frequent in distal MCAO (10 vs. 23%; p = 0.02). Among patients with proximal MCAO, hyperintense vessel sign was less frequently observed in those with a BG involvement than those without (38 vs. 60%; p = 0.03). Among those without BG involvement, the presence of HT was very low and similar between patients with proximal and distal MCAOs (1.9 vs. 2.0%). However, in patients with BG involvement, HT was more frequently observed in those with distal MCAO than in those with proximal MCAO (54.8 vs. 15.7%; p < 0.001). The presence of hyperintense vessel sign (OR 0.172, 95% CI 0.051–0.586; p = 0.005) and distal MCAO (OR 0.200, 95% CI 0.059–0.683; p = 0.011) was independently associated with improvement during admission. Conclusion: Proximal MCAO is more frequently associated with atherosclerosis, whereas distal MCAO is more frequently associated with cardioembolism. In proximal MCAO, the status of collateral flow presented by hyperintense vessel sign may affect the involvement of BG. In distal MCAO, distal migration of the embolus, which first impacted at the proximal MCA causing BG ischemia, may explain the high rate of HT by reperfusion injury. Hyperintense vessel sign and distal MCAO were independently associated with neurological improvement during admission.

更新日期：2019-01-01

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