Amano Yuki, Sano Hiroyasu, Fujimoto Ayataka, Kenmochi Hiroaki, Sato Haruhiko, Akamine Soichi
Department of Neurosurgery, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
Department of Stroke Center, Seirei Mikatahara General Hospital, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
Cerebrovasc Dis Extra. 2020;10(2):76-83. doi: 10.1159/000508090. Epub 2020 Jul 29.
Treatment for acute ischemic stroke due to large vessel occlusion (LVO) with mild symptoms is under discussion. Although most patients have good outcomes, some patients deteriorate and have unfavorable results. Imaging findings that predict the prognosis of LVO with mild symptoms are needed to identify patients who require treatment. In this study, we focused on watershed infarctions (WSIs), because this clinical phenomenon quite sensitively reflects changes in cerebral blood flow. The purpose of this study was to assess positive rates of WSI on MRI findings in patients with internal carotid artery (ICA) occlusion, and compare WSI-positive rates between patients divided according to their clinical course.
We retrospectively collected data of 1,531 patients who presented with acute ischemic stroke between June 2006 and July 2019. Among them, we chose symptomatic ICA occlusion patients with a past history of atrial fibrillation who were treated conservatively. We divided these patients into two groups, those with maintenance or improvement in their NIHSS score after hospitalization, and those whose NIHSS score worsened. We compared WSI-positive rates between these two groups.
Thirty-seven of the 1,531 patients were included in this study. Of them, total NIHSS score was maintained or improved in 8 patients (group A), 3 of whom (37.5%) had internal watershed infarctions (IWIs). In group B, consisting of patients whose NIHSS score worsened by >2 at 7 days from symptom onset, 24 (82.8%) had IWIs. Group A thus had statistically lower IWI positivity rates than group B (p = 0.02). Three patients (37.5%) in group A had cortical watershed infarctions (CWIs), while 27 patients in group B (93.1%) had CWIs. Group A thus had a significantly lower CWI positivity rate than group B (p = 0.002).
In patients with mildly symptomatic ICA occlusion, CWIs and IWIs might be key signs for predicting neurological deterioration after hospitalization.
对于症状轻微的大血管闭塞（LVO）所致急性缺血性卒中的治疗仍在讨论中。尽管大多数患者预后良好，但部分患者病情会恶化并出现不良后果。需要影像学检查结果来预测症状轻微的LVO患者的预后，以识别需要治疗的患者。在本研究中，我们重点关注分水岭梗死（WSIs），因为这一临床现象能相当敏感地反映脑血流变化。本研究的目的是评估颈内动脉（ICA）闭塞患者MRI检查结果中WSI的阳性率，并比较根据临床病程分组的患者之间WSI的阳性率。
我们回顾性收集了2006年6月至2019年7月期间出现急性缺血性卒中的1531例患者的数据。其中，我们选择了有房颤病史且接受保守治疗的有症状ICA闭塞患者。我们将这些患者分为两组，一组是住院后美国国立卫生研究院卒中量表（NIHSS）评分维持或改善的患者，另一组是NIHSS评分恶化的患者。我们比较了这两组之间WSI的阳性率。
1531例患者中有37例纳入本研究。其中，8例患者（A组）的NIHSS总分维持或改善，其中3例（37.5%）发生了脑内分水岭梗死（IWIs）。在B组中，由症状发作7天时NIHSS评分恶化>2分的患者组成，24例（82.8%）发生了IWIs。因此，A组的IWI阳性率在统计学上低于B组（p = 0.02）。A组有3例患者（37.5%）发生了皮质分水岭梗死（CWIs），而B组有27例患者（93.1%）发生了CWIs。因此，A组的CWI阳性率显著低于B组（p = 0.002）。
在症状轻微的ICA闭塞患者中，CWIs和IWIs可能是预测住院后神经功能恶化的关键征象。
