Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
J Neuroimaging. 2021 Jul;31(4):686-690. doi: 10.1111/jon.12863. Epub 2021 Apr 30.
In symptomatic intracranial atherosclerotic stenosis (ICAS), borderzone infarct pattern and perfusion mismatch are associated with increased risk of recurrent strokes, which may reflect the shared underlying mechanism of hypoperfusion distal to the intracranial atherosclerosis. Accordingly, we hypothesized a correlation between hypoperfusion volumes and ICAS infarct patterns based on the respective underlying mechanistic subtypes.
We conducted a retrospective analysis of consecutive symptomatic ICAS cases, acute strokes due to subocclusive (50%-99%) intracranial stenosis. The following mechanistic subtypes were assigned based on the infarct pattern on the diffusion-weighted imaging: Branch occlusive disease (BOD), internal borderzone (IBZ), and thromboembolic (TE). Perfusion parameters, obtained concurrently with the MRI, were studied in each group.
A total of 42 patients (57% women, mean age 71 ± 13 years old) with symptomatic ICAS received MRI within 24 h of acute presentation. Fourteen IBZ, 11 BOD, and 17 TE patterns were identified. IBZ pattern yielded higher total T > 4 s and T > 6 s perfusion delay volumes, as well as corresponding T > 4 s and T > 6 s mismatch volume, compared to BOD. TE pattern exhibited greater median T > 6 s hypoperfusion delay in volume compared to BOD. In IBZ versus TE, the volume difference between T > 4 s and T > 6 s (Δ T > 4 s - T > 6 s) was substantially greater.
ICAS infarct patterns, in keeping with their respective underlying mechanisms, may correlate with distinct perfusion profiles.
在有症状的颅内动脉粥样硬化性狭窄（ICAS）中，交界区梗死模式和灌注不匹配与复发性卒中风险增加相关，这可能反映了颅内动脉粥样硬化远端低灌注的共同潜在机制。因此，我们假设根据各自的潜在机制亚型，低灌注体积与 ICAS 梗死模式之间存在相关性。
我们对连续的症状性 ICAS 病例进行了回顾性分析，这些病例是由于亚闭塞性（50%-99%）颅内狭窄引起的急性卒中。根据弥散加权成像上的梗死模式，将以下机制亚型分配：分支闭塞性疾病（BOD）、内交界区（IBZ）和血栓栓塞（TE）。在每组中研究了与 MRI 同时获得的灌注参数。
共有 42 名（57%为女性，平均年龄 71±13 岁）有症状的 ICAS 患者在急性发作后 24 小时内接受了 MRI 检查。确定了 14 例 IBZ、11 例 BOD 和 17 例 TE 模式。与 BOD 相比，IBZ 模式产生了更高的总 T >4 s 和 T >6 s 灌注延迟体积，以及相应的 T >4 s 和 T >6 s 不匹配体积。TE 模式与 BOD 相比，表现出更大的中位数 T >6 s 低灌注延迟体积。在 IBZ 与 TE 之间，T >4 s 和 T >6 s 之间的体积差异（Δ T >4 s - T >6 s）明显更大。
与各自的潜在机制一致，ICAS 梗死模式可能与不同的灌注特征相关。
