Sangha Rajbeer S, Prabhakaran Shyam, Feldmann Edward, Honda Tristan, Nizam Azhar, Cotsonis George A, Campo-Bustillo Iszet, Romano Jose G, Liebeskind David S
Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States.
Department of Neurology, The University of Chicago, Chicago, IL, United States.
Front Neurol. 2021 Jan 21;11:615094. doi: 10.3389/fneur.2020.615094. eCollection 2020.
While much is known about recurrent clinical events in patients with intracranial atherosclerotic disease (ICAD), there is limited data on characteristics of recurrent infarcts. The NIH-funded MyRIAD prospective, observational study was designed to identify mechanisms of ischemia and predictors of recurrence in ICAD. Recurrent infarction was assessed on MRI at 6-8 weeks. We reviewed the DWI/ADC and FLAIR sequences in patients with recurrent stroke and characterized the number of infarcts, infarct location, size, and patterns based on whether they were borderzone (BZ), perforator (SC/P), cortical or territorial (C/T), and mixed. Temporal characteristics were delineated by ADC/FLAIR correlation. Of the 89 patients with 6-8 weeks MRI, 22 (24.7%) had recurrent infarcts in the territory of the symptomatic artery. Recurrent infarcts were evident on DWI in 63.6% and single infarcts in 54.5%. The median recurrent infarct volume was 2.0 cm compared to median index infarct volumes of 2.5 cm. A mixed infarct pattern was most common (40.9%), followed by borderzone (22.7%), cortical or territorial (27.3%), while only 9.1% were in a perforator artery distribution. Amongst those with a mixed pattern, 8/9 had a borderzone distribution infarct as part of their mixed infarct pattern. These findings provide novel data on the characteristics of early recurrent infarcts in patients with symptomatic ICAD.
虽然颅内动脉粥样硬化疾病（ICAD）患者复发临床事件的情况已为人熟知，但关于复发性梗死特征的数据却很有限。由美国国立卫生研究院资助的MyRIAD前瞻性观察性研究旨在确定ICAD患者缺血机制及复发预测因素。在6至8周时通过磁共振成像（MRI）评估复发性梗死情况。我们回顾了复发性卒中患者的弥散加权成像/表观扩散系数（DWI/ADC）和液体衰减反转恢复序列（FLAIR），并根据梗死灶是否为边缘带（BZ）、穿支（SC/P）、皮质或区域（C/T）以及混合型，对梗死灶数量、梗死灶位置、大小和模式进行了特征描述。通过ADC/FLAIR相关性描绘时间特征。在89例接受了6至8周MRI检查的患者中，22例（24.7%）在症状性动脉供血区域出现了复发性梗死。在DWI上，63.6%的复发性梗死灶明显可见，54.5%为单个梗死灶。复发性梗死灶的中位体积为2.0立方厘米，而首次梗死灶的中位体积为2.5立方厘米。混合型梗死模式最为常见（40.9%），其次是边缘带（22.7%）、皮质或区域型（27.3%），而穿支动脉分布的梗死灶仅占9.1%。在混合型梗死模式的患者中，8/9的患者有边缘带分布的梗死灶作为其混合型梗死模式的一部分。这些发现为有症状ICAD患者早期复发性梗死的特征提供了新的数据。
