Kim Y D, Choi H Y, Jung Y H, Nam C M, Yang J H, Cho H J, Nam H S, Lee K-Y, Heo J H
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
Eur J Neurol. 2009 Oct;16(10):1159-64. doi: 10.1111/j.1468-1331.2009.02690.x. Epub 2009 May 22.
Although it has been suggested that bilateral symmetry of atherosclerosis can be found in paired arteries, including external carotid arteries and femoral arteries, it has remained unknown in intracranial arteries. We determined whether bilateral symmetry (a mirror pattern) of atherosclerosis presents in the entire cerebral arterial system.
Angiographic findings of 795 consecutive patients with ischaemic stroke, after excluding those with cardiac sources of embolism or other causes of stroke, were reviewed retrospectively. The presence (location) and severity (the degree of stenosis) of atherosclerosis were compared between left and right sides at 26 predetermined arteries/segments.
We found 2230 lesions in predetermined segments/arteries from 669 patients. Amongst 509 patients with atherosclerotic lesions at two or more arteries/segments, mirror patterns were observed in 312 patients (61.3%). The mirror pattern increased steeply as the number of atherosclerotic arteries increased and was most frequently found in the carotid bulb (C1, 26.7%), followed by the middle cerebral artery (M1, 14.1%). The severity of stenosis was also correlated between left and right sides, and the correlation was highest in the C1 (r = 0.40, P < 0.001). Multiple logistic regression analyses revealed that the mirror patterns of atherosclerosis were more obvious in C1 and associated with a past history of ischaemic stroke and the number of stenotic lesions.
Atherosclerosis in cerebral arteries may develop and progress in a mirror pattern. In patients with cerebral artery atherosclerosis, the occurrence and progression of atherosclerosis in the contralateral cerebral artery should be considered during follow-up examination.
尽管有人提出，在包括颈外动脉和股动脉在内的成对动脉中可发现动脉粥样硬化的双侧对称性，但颅内动脉中的情况仍不清楚。我们确定了动脉粥样硬化的双侧对称性（镜像模式）是否存在于整个脑动脉系统中。
回顾性分析795例连续缺血性卒中患者的血管造影结果，排除有心源性栓塞或其他卒中病因的患者。比较了26个预定动脉/节段左右两侧动脉粥样硬化的存在情况（位置）和严重程度（狭窄程度）。
我们在669例患者的预定节段/动脉中发现了2230处病变。在509例有两处或更多动脉/节段存在动脉粥样硬化病变的患者中，312例（61.3%）观察到镜像模式。随着动脉粥样硬化动脉数量的增加，镜像模式急剧增加，最常见于颈动脉球部（C1，26.7%），其次是大脑中动脉（M1，14.1%）。左右两侧狭窄程度也具有相关性，在C1处相关性最高（r = 0.40，P < 0.001）。多因素logistic回归分析显示，动脉粥样硬化的镜像模式在C1处更明显，且与既往缺血性卒中病史和狭窄病变数量有关。
脑动脉粥样硬化可能以镜像模式发展和进展。在脑动脉粥样硬化患者的随访检查中，应考虑对侧脑动脉粥样硬化的发生和进展情况。
