UCLA Stroke Center, Los Angeles, CA 90095, USA.
J Neurol Neurosurg Psychiatry. 2012 Jun;83(6):586-90. doi: 10.1136/jnnp-2011-301493. Epub 2012 Apr 4.
To investigate whether anterior choroidal artery (AChA) territory sparing or AChA infarction restricted to the medial temporal lobe (MT), implying good collateral status, predicts good outcome, defined as modified Rankin Scale 0-2, at discharge in acute internal carotid artery (ICA) occlusion.
The authors studied consecutive patients with acute ICA occlusion admitted to an academic medical centre between January 2002 and August 2010, who underwent MRI followed by conventional angiography. The pattern of AChA involvement on initial diffusion-weighted imaging was dichotomised as spared or MT only versus other partial or full. The association of AChA infarct patterns and good outcome at discharge was calculated by multivariate logistic regression with adjustment.
For the 60 patients meeting entry criteria, mean age was 68.3 years and median admission NIH Stroke Scale score was 19. AChA territory was spared or restricted to the MT in 27 patients and other partially involved or fully involved in 33 patients. AChA territory spared or ischaemia restricted to MT only, compared with other partial infarct patterns or full infarct, was independently associated with good discharge outcome (44.4% vs 12.1%, OR 7.24, 95% CI 1.32 to 39.89, p=0.023).
In acute ICA occlusion, the absence of AChA infarction or restriction to the MT is an independent predictor of good discharge outcome. Analysis of AChA infarct patterns may improve early prognostication and decision-making.
探讨颈内动脉（ICA）急性闭塞患者，大脑前动脉（AChA）穿通支区域是否受累或仅局限于内侧颞叶（MT）的 AChA 梗死，是否提示良好的侧支循环状态，对出院时改良 Rankin 量表（mRS）评分 0-2 分的良好结局有预测价值。
作者对 2002 年 1 月至 2010 年 8 月期间，在学术医学中心连续收治的急性 ICA 闭塞患者进行了研究，所有患者均接受 MRI 检查后进行常规血管造影。根据初始弥散加权成像上 AChA 受累模式，将 AChA 受累情况分为未受累或仅累及 MT 与其他部分受累或完全受累。采用多变量逻辑回归分析并调整了 AChA 梗死模式与出院时良好结局的关系。
对于符合纳入标准的 60 例患者，平均年龄为 68.3 岁，入院 NIH 卒中量表评分中位数为 19。27 例患者 AChA 区域未受累或仅累及 MT，33 例患者 AChA 部分受累或完全受累。与其他部分梗死模式或完全梗死相比，AChA 区域未受累或仅累及 MT 的患者出院时预后良好的比例更高（44.4% vs 12.1%，OR 7.24，95%CI 1.32-39.89，p=0.023）。
在急性 ICA 闭塞中，AChA 未受累或局限于 MT 的患者具有良好的出院结局。AChA 梗死模式分析可能有助于改善早期预后判断和决策。
