Department of Cerebrovascular Disease, Cerebrovascular Center and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Nippon Steel Yawata Memorial Hospital, Harunomachi, Kitakyushu, Japan.
Cerebrovasc Dis. 2011;32(2):148-54. doi: 10.1159/000328652. Epub 2011 Jul 20.
The purpose of the present study was to clarify the difference in the infarct topography on diffusion-weighted image (DWI) and cardiac and aortic findings on transesophageal echocardiography (TEE) in stroke patients with different embolic sources.
We studied 270 consecutive patients with acute ischemic stroke who had DWI-documented cortical or subcortical infarcts without significant stenosis of the cerebral arteries. As embolic sources, cardiac diseases, right-to-left shunt diseases and an aortic arch atheroma ≥4.0 mm in thickness were identified using various diagnostic tools including TEE.
Seventy-eight (29%) patients had multiple embolic sources. Large infarcts were common in patients in whom cardiac disease was the only embolic source and uncommon in patients in whom aortic atheroma was the only embolic source (p < 0.0001). Vertebrobasilar infarcts were relatively common in patients only having aortic atheromas. Atrial septal aneurysms were more common in patients with a right-to-left shunt than in those with a shunt plus other embolic sources (p = 0.0036). Unique characteristics of the arch atheroma (mobile plaque, extension to branches, or ulcer formation; p < 0.0001) as well as small or moderate-sized infarcts (p = 0.0004) were more common in patients with arch atheromas as the only embolic source than in those with atheromas plus other embolic sources.
Embolic stroke patients often have multiple embolic sources. The present study suggests the possibility that embolic stroke has unique clinical features depending on its source. DWI and TEE findings might be helpful in characterizing cardiogenic, paradoxical and aortogenic brain embolism.
本研究旨在阐明不同栓塞源的卒中患者弥散加权成像（DWI）梗死部位与经食管超声心动图（TEE）心脏和主动脉表现的差异。
我们研究了 270 例连续的急性缺血性卒中患者，这些患者的 DWI 均证实有皮质或皮质下梗死，且大脑动脉无明显狭窄。使用包括 TEE 在内的各种诊断工具确定心脏疾病、右向左分流疾病和厚度≥4.0mm 的主动脉弓粥样斑块等作为栓塞源。
78 例（29%）患者存在多种栓塞源。心脏疾病是唯一栓塞源的患者中常见大梗死，而主动脉粥样斑块是唯一栓塞源的患者中则少见大梗死（p<0.0001）。仅存在主动脉粥样斑块的患者中椎基底动脉梗死相对常见。存在右向左分流的患者中房间隔动脉瘤比存在分流加其他栓塞源的患者更常见（p=0.0036）。独特的弓粥样斑块特征（活动斑块、分支延伸或溃疡形成；p<0.0001）以及小或中等大小梗死（p=0.0004）在仅以弓粥样斑块为唯一栓塞源的患者中比在同时存在粥样斑块和其他栓塞源的患者中更为常见。
栓塞性卒中患者常存在多种栓塞源。本研究提示，栓塞性卒中可能因其来源而具有独特的临床特征。DWI 和 TEE 检查结果可能有助于对心源性、矛盾性和主动脉源性脑栓塞进行特征描述。
