Bang O Y, Lee P H, Yoon S R, Lee M A, Joo I S, Huh K
Department of Neurology, College of Medicine, Ajou University, Woncheon-dong San 5, Suwon, Kyungki-do, 442-749, Republic of Korea.
J Neurol Neurosurg Psychiatry. 2005 Aug;76(8):1128-34. doi: 10.1136/jnnp.2004.054403.
The apparent differences in risk factors for intra- and extracranial atherosclerosis are unclear and the mechanisms that underlie strokes in patients with intracranial atherosclerosis are not well known. We investigated the conventional vascular risk factors as well as other factors in stroke patients with large artery atherosclerosis.
Using diffusion weighted imaging (DWI) and vascular and cardiologic studies, we selected patients with acute non-cardioembolic cerebral infarcts within the middle cerebral artery (MCA) territory. Patients were divided into two groups: those with atherosclerotic lesions on the carotid sinus (n = 112) and those with isolated lesions on the proximal MCA (n = 160). Clinical features, risk factors, and DWI patterns were compared between groups.
There were no differences in conventional risk factors, but markers for inflammation were significantly higher in patients with carotid atherosclerosis than in those with isolated MCA atherosclerosis (p < 0.01 for both). After adjustments for age/sex and the severity of stroke, an inverse correlation was observed between C-reactive protein levels and MCA atherosclerosis (odds ratio 0.57 per 1 mg/dl increase; 95% confidence interval 0.35 to 0.92; p = 0.02). Internal borderzone infarcts suggestive of haemodynamic causes were the most frequent DWI pattern in patients with MCA occlusion, whereas territorial infarcts suggesting plaque ruptures were most common in those with carotid occlusion.
Our results indicate that inflammatory markers, rather than conventional risk factors, reveal clinical and radiological differences between patients with carotid and MCA atherosclerosis. Plaques associated with MCA atherosclerosis may be more stable than those associated with carotid atherosclerosis.
颅内和颅外动脉粥样硬化危险因素的明显差异尚不清楚，颅内动脉粥样硬化患者中风的潜在机制也尚不明确。我们研究了大动脉粥样硬化性中风患者的传统血管危险因素以及其他因素。
利用弥散加权成像（DWI）以及血管和心脏检查，我们选取了大脑中动脉（MCA）区域内急性非心源性脑梗死患者。患者被分为两组：颈动脉窦有动脉粥样硬化病变的患者（n = 112）和MCA近端有孤立病变的患者（n = 160）。比较两组患者的临床特征、危险因素和DWI表现。
传统危险因素方面无差异，但颈动脉粥样硬化患者的炎症标志物显著高于孤立性MCA粥样硬化患者（两者p均<0.01）。在对年龄/性别和中风严重程度进行校正后，观察到C反应蛋白水平与MCA粥样硬化呈负相关（每增加1mg/dl，比值比为0.57；95%置信区间为0.35至0.92；p = 0.02）。提示血流动力学原因的内分水岭梗死是MCA闭塞患者最常见的DWI表现，而提示斑块破裂的区域梗死在颈动脉闭塞患者中最为常见。
我们的结果表明，炎症标志物而非传统危险因素揭示了颈动脉和MCA粥样硬化患者之间的临床和影像学差异。与MCA粥样硬化相关的斑块可能比与颈动脉粥样硬化相关的斑块更稳定。
