Lee Eun-Jae, Cho Yong-Pil, Lee Sang-Hun, Lee Ji Sung, Nam Hyo Jung, Kim Bum Joon, Kwon Tae-Won, Kang Dong-Wha, Kim Jong S, Kwon Sun U
Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Korea.
Department of Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea.
J Am Heart Assoc. 2016 Oct 4;5(10):e004153. doi: 10.1161/JAHA.116.004153.
Hemodynamic tandem intracranial lesions (TILs) on intracranial magnetic resonance angiography, which develop flow dependently, have been overlooked clinically in patients undergoing carotid endarterectomy. As they represent severe baseline hemodynamic compromise at the segment, they may be associated with distinctive clinical outcomes.
We assessed 304 consecutive carotid endarterectomy cases treated over 3 years. Included cases had both preoperative and postoperative intracranial 3-dimensional time-of-flight magnetic resonance angiography, of which signal intensities are flow dependent, and postoperative diffusion-weighted imaging (≤3 days following carotid endarterectomy). Preoperative TILs in the ipsilateral intracranial arteries were evaluated by the presence of nonexclusive components: focal stenosis (>50%), diffuse stenosis (>50%), and decreased signal intensities (>50%). The components showing postoperative normalization were considered hemodynamic. TILs with hemodynamic components were defined as hemodynamic TILs, while others as consistent TILs. Baseline characteristics and postoperative outcomes were analyzed among 3 groups: no TILs, consistent TILs, and hemodynamic TILs. Preoperative TILs were identified in 104 (34.2%) cases; 54 (17.8%) had hemodynamic components. Diffuse stenosis and decreased signal intensities were usually reversed postoperatively. Patients with hemodynamic TILs tended to have severe proximal carotid stenosis and recent strokes (≤14 days). For the outcome, hemodynamic TILs were independently associated with the advent of postoperative ischemic lesions on diffusion-weighted imaging (odds ratio: 2.50; 95% CI, 1.20-5.20).
In patients undergoing carotid endarterectomy, a significant number of preoperative TILs demonstrated hemodynamic components, which were reversed postoperatively. The presence of such components was distinctively associated with the postoperative incidence of new ischemic lesions.
颅内磁共振血管造影上的血流动力学串联性颅内病变（TILs），其发展依赖血流，在接受颈动脉内膜切除术的患者中临床上一直被忽视。由于它们代表该节段严重的基线血流动力学受损，可能与独特的临床结局相关。
我们评估了3年内连续治疗的304例颈动脉内膜切除术病例。纳入的病例术前行颅内三维时间飞跃磁共振血管造影（其信号强度依赖血流），术后行弥散加权成像（颈动脉内膜切除术后≤3天）。通过以下非排他性成分评估同侧颅内动脉术前TILs：局灶性狭窄（>50%）、弥漫性狭窄（>50%）和信号强度降低（>50%）。术后恢复正常的成分被视为血流动力学成分。具有血流动力学成分的TILs被定义为血流动力学TILs，其他的为持续性TILs。分析了三组（无TILs、持续性TILs和血流动力学TILs）的基线特征和术后结局。104例（34.2%）病例术前发现有TILs；54例（17.8%）有血流动力学成分。弥漫性狭窄和信号强度降低术后通常会逆转。有血流动力学TILs的患者往往有严重的近端颈动脉狭窄和近期卒中（≤14天）。就结局而言，血流动力学TILs与弥散加权成像上术后缺血性病变的出现独立相关（比值比：2.50；95%可信区间，1.20 - 5.20）。
在接受颈动脉内膜切除术的患者中，大量术前TILs显示有血流动力学成分，术后这些成分会逆转。这些成分的存在与术后新发缺血性病变的发生率显著相关。
Zotero 插件