Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
J Cereb Blood Flow Metab. 2021 Oct;41(10):2690-2698. doi: 10.1177/0271678X211011288. Epub 2021 Apr 25.
Cerebral cortical microinfarcts (CMI) are small ischemic lesions that are associated with cognitive impairment and probably have multiple etiologies. Cerebral hypoperfusion has been proposed as a causal factor. We studied CMI in patients with internal carotid artery (ICA) occlusion, as a model for cerebral hemodynamic compromise. We included 95 patients with a complete ICA occlusion (age 66.2 ± 8.3, 22% female) and 125 reference participants (age 65.5 ± 7.4, 47% female). Participants underwent clinical, neuropsychological, and 3 T brain MRI assessment. CMI were more common in patients with an ICA occlusion (54%, median 2, range 1-33) than in the reference group (6%, median 0; range 1-7; OR 14.3; 95% CI 6.2-33.1; <.001). CMI were more common ipsilateral to the occlusion than in the contralateral hemisphere (median 2 and 0 respectively; <.001). In patients with CMI compared to patients without CMI, the number of additional occluded or stenosed cervical arteries was higher (=.038), and cerebral blood flow was lower (B -6.2 ml/min/100 ml; 95% CI -12.0:-0.41; =.036). In conclusion, CMI are common in patients with an ICA occlusion, particularly in the hemisphere of the occluded ICA. CMI burden was related to the severity of cervical arterial compromise, supporting a role of hemodynamics in CMI etiology.
大脑皮质微梗死（CMI）是与认知障碍相关的小面积缺血性病变，可能有多种病因。脑灌注不足被认为是一个致病因素。我们研究了颈内动脉（ICA）闭塞患者的 CMI，作为脑血流动力学受损的模型。我们纳入了 95 例完全 ICA 闭塞患者（年龄 66.2±8.3 岁，22%为女性）和 125 名参考参与者（年龄 65.5±7.4 岁，47%为女性）。参与者接受了临床、神经心理学和 3T 脑部 MRI 评估。ICA 闭塞患者的 CMI 更为常见（54%，中位数 2，范围 1-33），而参考组则较少（6%，中位数 0，范围 1-7；OR 14.3；95%CI 6.2-33.1；<.001）。与对侧半球相比，CMI 更常见于闭塞同侧（中位数分别为 2 和 0；<.001）。与无 CMI 的患者相比，有 CMI 的患者中额外闭塞或狭窄的颈内动脉数量更高（=.038），脑血流更低（B -6.2ml/min/100ml；95%CI -12.0:-0.41；=.036）。总之，ICA 闭塞患者中 CMI 很常见，特别是在闭塞的 ICA 半球。CMI 负担与颈内动脉病变严重程度相关，支持血流动力学在 CMI 发病机制中的作用。
