Man Bik Ling, Fu Yat Pang, Chan Yin Yan, Lam Wynnie, Hui Andrew Chi Fai, Leung Wai Hong, Mok Vincent, Wong Ka Sing
Division of Neurology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, China.
Stroke. 2009 Oct;40(10):3211-5. doi: 10.1161/STROKEAHA.109.557041. Epub 2009 Jul 30.
Concurrent atherosclerosis of the intracranial and extracranial cerebrovascular system is common in Asians. The typical lesion patterns and the mechanisms of stroke in patients with concurrent stenoses are unclear. This study aimed to determine these stroke features of such patients in Hong Kong.
We conducted a cross-sectional cohort study in a university hospital from January 2002 to December 2003. Consecutive Chinese patients with acute ischemic stroke underwent CT brain, MRI brain (with MR angiography and diffusion-weighted imaging sequences), and carotid duplex.
In total, 251 patients were included in the analysis. Of these, 109 (43%) had concurrent stenoses. Patients who had concurrent stenoses, as compared with those without concurrent stenoses, had more symptomatic stenoses (84% versus 58%; OR, 4.0; 95% CI, 2.1 to 7.3; P<0.001), more concomitant perforating artery infarct, pial infarct, and borderzone infarct (14% versus 4%; OR, 3.6; 95% CI, 1.4 to 9.7; P=0.007), more multiple diffusion-weighted imaging lesions (55% versus 37%; OR, 2.1; 95% CI, 1.3 to 3.4; P=0.005), and more infarcts in the territory of the leptomeningeal branches of middle cerebral artery (26% versus 13%; OR, 2.2; 95% CI, 1.2 to 4.3; P=0.01). In multivariate regression analysis, smoking; prior stroke; the presence of concomitant pial infarct, pial infarct, and borderzone infarcts; multiple diffusion-weighted imaging lesions; and symptomatic stenoses were significantly associated with concurrent stenoses. Among patients with concurrent stenoses, those who had tandem lesions, as compared with those who had nontandem lesions, had more perforating artery infarct and borderzone infarcts (27% versus 8%; OR, 4.3; 95% CI, 0.9 to 19.8; P=0.04); more concomitant pial infarct, pial infarct, and borderzone infarcts (18% versus 0%; P=0.02), and more multiple diffusion-weighted imaging lesions (65% versus 23%; OR, 6.2; 95% CI, 2.2 to 17.2; P<0.001). Infarcts in the territory of middle cerebral artery leptomeningeal branches and symptomatic stenoses were more common in patients with tandem lesions.
Concomitant perforating artery infarct, pial infarct, and borderzone infarcts; multiple diffusion-weighted imaging lesions, and infarcts in the leptomeningeal branches of the middle cerebral artery were more common in patients with concurrent stenoses, especially those with tandem lesions. This study suggested that the combination of hemodynamic compromise attributable to concurrent stenoses and artery-to-artery embolization is a common stroke mechanism in these patients.
颅内和颅外脑血管系统并发动脉粥样硬化在亚洲人中很常见。并发狭窄患者的典型病变模式及卒中机制尚不清楚。本研究旨在确定香港此类患者的这些卒中特征。
2002年1月至2003年12月期间，我们在一家大学医院进行了一项横断面队列研究。连续纳入急性缺血性卒中的中国患者，进行头颅CT、头颅MRI（包括磁共振血管造影和弥散加权成像序列）及颈动脉双功超声检查。
总共251例患者纳入分析。其中，109例（43%）并发狭窄。与无并发狭窄的患者相比，并发狭窄的患者有更多有症状的狭窄（84%对58%；比值比，4.0；95%可信区间，2.1至7.3；P<0.001），更多合并穿支动脉梗死、软脑膜梗死和边缘带梗死（14%对4%；比值比，3.6；95%可信区间，1.4至9.7；P=0.007），更多多发弥散加权成像病变（55%对37%；比值比，2.1；95%可信区间，1.3至3.4；P=0.005），以及更多大脑中动脉软脑膜分支供血区梗死（26%对13%；比值比，2.2；95%可信区间，1.2至4.3；P=0.01）。多因素回归分析显示，吸烟、既往卒中、合并软脑膜梗死、软脑膜梗死和边缘带梗死、多发弥散加权成像病变以及有症状的狭窄与并发狭窄显著相关。在并发狭窄的患者中，与非串联病变患者相比，串联病变患者有更多穿支动脉梗死和边缘带梗死（27%对8%；比值比，4.3；95%可信区间，0.9至19.8；P=0.04），更多合并软脑膜梗死、软脑膜梗死和边缘带梗死（18%对0%；P=0.02），以及更多多发弥散加权成像病变（65%对23%；比值比，6.2；95%可信区间，2.2至17.2；P<0.001）。大脑中动脉软脑膜分支供血区梗死和有症状的狭窄在串联病变患者中更常见。
并发狭窄的患者，尤其是串联病变患者，合并穿支动脉梗死、软脑膜梗死和边缘带梗死、多发弥散加权成像病变以及大脑中动脉软脑膜分支供血区梗死更为常见。本研究提示，并发狭窄导致的血流动力学损害与动脉到动脉栓塞相结合是这些患者常见的卒中机制。
