Department of Neurology Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Manhasset NY.
Department of Radiology Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Manhasset NY.
J Am Heart Assoc. 2022 Mar;11(5):e023991. doi: 10.1161/JAHA.121.023991. Epub 2022 Feb 16.
Background Treatment and prognosis of vertebrobasilar atherosclerotic disease differs depending on stroke mechanism, such as artery-to-artery embolism, branch atheromatous disease, and hemodynamic ischemia. Our aim was to investigate the relationship between infarction pattern and flow status using quantitative magnetic resonance angiography (QMRA), to determine the validity of using infarction patterns to infer stroke mechanism. Methods and Results This is a retrospective study of patients with ischemic stroke with intra- or extracranial vertebrobasilar atherosclerotic stenosis, who underwent magnetic resonance imaging of the brain, neurovascular imaging, and QMRA, between 2009 and 2021. Patients with cerebral infarction predating or following QMRA by ≥1 year, or QMRA studies performed for basilar thrombosis, vertebral dissection, or only postangioplasty/stenting, were excluded. Poststenotic flow (basilar and posterior cerebral arteries) was dichotomized as low-flow or normal-flow based on published criteria. Of 1211 consecutive patients who underwent QMRA noninvasive optimal analysis, 69 met inclusion. Mixed patterns were most common (46.4%), followed by perforator (23.2%), borderzone (14.5%), and territorial (15.9%). Patients with low-flow had a significantly higher rate of borderzone+ patterns (borderzone alone or in mixed pattern) compared with patients with normal-flow (77.4% low-flow versus 39.5% normal-flow, =0.002). Borderzone+ patterns were associated with 61.5% probability of low-flow state, while no borderzone (perforator/territorial) patterns were associated with 76.7% probability of normal-flow state. Conclusions Borderzone infarction pattern (alone or mixed) was associated with low poststenotic posterior circulation flow by QMRA. However, borderzone pattern only moderately predicted low-flow state, and may be an unreliable flow marker. Therefore, infarct topography may complement, but should not replace hemodynamic studies to establish flow status.
椎基底动脉粥样硬化疾病的治疗和预后因卒中机制而异，如动脉到动脉栓塞、分支粥样硬化病变和血液动力学缺血。我们的目的是通过定量磁共振血管造影（QMRA）研究梗死模式与血流状态之间的关系，以确定使用梗死模式推断卒中机制的有效性。
这是一项回顾性研究，纳入了 2009 年至 2021 年间，因颅内或颅外椎基底动脉粥样硬化性狭窄而接受脑磁共振成像、神经血管成像和 QMRA 的缺血性卒中患者。排除了 QMRA 研究前或后≥1 年出现脑梗死、基底动脉血栓形成、椎动脉夹层或仅行血管成形术/支架置入术的患者。根据发表的标准，将后狭窄段血流（基底动脉和大脑后动脉）分为低血流或正常血流。在 1211 例连续接受 QMRA 无创最佳分析的患者中，69 例符合纳入标准。混合模式最常见（46.4%），其次是穿支（23.2%）、交界区（14.5%）和皮质区（15.9%）。与正常血流患者相比，低血流患者交界区+模式（交界区单独或混合模式）的发生率明显更高（77.4%低血流患者与 39.5%正常血流患者，=0.002）。交界区+模式与低血流状态的发生相关，其概率为 61.5%，而无交界区（穿支/皮质区）模式与正常血流状态的发生相关，其概率为 76.7%。
交界区梗死模式（单独或混合）与 QMRA 后狭窄段后循环血流低有关。然而，交界区模式仅能中度预测低血流状态，且可能是一种不可靠的血流标志物。因此，梗死部位可能起到补充作用，但不应替代血液动力学研究来确定血流状态。
