Gold Menachem, Khamesi Mojdeh, Sivakumar Mangaiyarkkarasi, Natarajan Vijaya, Motahari Hooman, Caputo Nicholas
Department of Radiology, Lincoln Medical Center, Bronx, New York.
Department of Internal Medicine, Lincoln Medical Center, Bronx, New York.
Clin Anat. 2018 Apr;31(3):310-313. doi: 10.1002/ca.23045. Epub 2018 Jan 25.
Left-hemispheric ischemic strokes are more frequent overall and often have a worse outcome than their right-hemispheric counterparts. We hypothesized that the right-left propensity of CE cerebral infarcts differs between patients with standard and bovine arch variants. We retrospectively identified all patients with acute stroke of the anterior circulation admitted to our primary stroke center between January 2011 and June 2017 who had moderate- to high-risk cardio-embolic sources according to the SSS-TOAST classification. From amongst these patients, only those with available cross-sectional imaging of the aortic arch were included. Lesion side and patterns on diffusion-weighted magnetic resonance imaging were determined blinded to the aortic arch imaging. One hundred and nineteen patients met the TOAST criteria for moderate- or high-risk cardio-embolic source. Of these, 58 (49%) were men and the median age was 71.9 years; 33% of the patients had a bovine arch. The most common etiologies of CE were atrial fibrillation (n = 80 [67%]) and congestive heart failure with ejection fraction <30% (n = 18 [15%]). In patients with bovine arch there was an approximately 50% chance of having a right- or left-sided infarct. Although there was a trend towards right-sided lesions in patients with standard arches, this did not reach statistical significance. No statistically significant difference in embolic stroke laterality was demonstrated in our relatively small sample. Bovine arch could be an independent risk factor for cardio-embolic embolism. Clin. Anat. 31:310-313, 2018. © 2018 Wiley Periodicals, Inc.
总体而言，左半球缺血性中风比右半球缺血性中风更常见，且预后往往更差。我们推测，标准主动脉弓变异型和牛型主动脉弓变异型患者的心脏栓塞性脑梗死左右倾向存在差异。我们回顾性纳入了2011年1月至2017年6月期间入住我们初级卒中中心的所有急性前循环卒中患者，这些患者根据SSS-TOAST分类有中度至高度风险的心源性栓塞来源。在这些患者中，仅纳入那些有主动脉弓横断面影像资料的患者。在不知道主动脉弓影像结果的情况下确定弥散加权磁共振成像上的病变侧别和模式。119例患者符合中度或高度风险的心源性栓塞来源的TOAST标准。其中，58例（49%）为男性，中位年龄为71.9岁；33%的患者有牛型主动脉弓。心脏栓塞最常见的病因是心房颤动（n = 80 [67%]）和射血分数<30%的充血性心力衰竭（n = 18 [15%]）。在有牛型主动脉弓的患者中，左右侧梗死的几率约为50%。尽管标准主动脉弓患者有右侧病变的趋势，但未达到统计学意义。在我们相对较小的样本中，栓塞性中风的侧别未显示出统计学上的显著差异。牛型主动脉弓可能是心源性栓塞的独立危险因素。临床解剖学杂志31:310 - 313，2018年。©2018威利期刊公司。
