Woo Ho Geol, Kim Hyug-Gi, Lee Kyung Mi, Ha Sang Hee, Jo HangJin, Heo Sung Hyuk, Chang Dae-Il, Liebeskind David S, Kim Bum Joon
Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea.
Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea.
J Stroke. 2023 Jan;25(1):132-140. doi: 10.5853/jos.2022.02754. Epub 2023 Jan 31.
Various mechanisms are involved in the etiology of stroke caused by atherosclerosis of the middle cerebral artery (MCA). Here, we compared differences in plaque nature and hemodynamic parameters according to stroke mechanism in patients with MCA atherosclerosis.
Consecutive patients with asymptomatic and symptomatic MCA atherosclerosis (≥50% stenosis) were enrolled. MCA plaque characteristics (location and plaque enhancement) and wall shear stress (WSS) were measured using high-resolution vessel wall and four-dimensional flow magnetic resonance imaging, respectively, at five points (initial, upstream, minimal lumen, downstream, and terminal). These parameters were compared between patients with asymptomatic and symptomatic MCA atherosclerosis with infarctions of different mechanisms (artery-to-artery embolism vs. local branch occlusion).
In total, 110 patients (46 asymptomatic, 32 artery-to-artery embolisms, and 32 local branch occlusions) were investigated. Plaques were evenly distributed in the MCA of patients with asymptomatic MCA atherosclerosis, more commonly observed in the distal MCA of patients with artery-to-artery embolism, and in the middle MCA of patients with local branch occlusion. Maximum WSS and plaque enhancement were more prominent in the minimum lumen area of patients with asymptomatic MCA atherosclerosis or those with local branch occlusion, and were more prominent in the upstream area in those with artery-to-artery embolism. The elevated variability in the maximum WSS was related to stroke caused by artery-to-artery embolism.
Stroke caused by artery-to-artery embolism was related to plaque enhancement and the highest maximum WSS at the upstream point of the plaque, and was associated with elevated variability of maximum WSS.
大脑中动脉（MCA）动脉粥样硬化所致卒中的病因涉及多种机制。在此，我们比较了MCA动脉粥样硬化患者中根据卒中机制的斑块性质和血流动力学参数的差异。
纳入连续的无症状和有症状的MCA动脉粥样硬化（狭窄≥50%）患者。分别使用高分辨率血管壁成像和四维血流磁共振成像在五个点（起始点、上游、最小管腔、下游和末端）测量MCA斑块特征（位置和斑块强化）和壁面剪应力（WSS）。对无症状和有症状的MCA动脉粥样硬化且梗死机制不同（动脉到动脉栓塞与局部分支闭塞）的患者的这些参数进行比较。
总共研究了110例患者（46例无症状，32例动脉到动脉栓塞，32例局部分支闭塞）。斑块在无症状MCA动脉粥样硬化患者的MCA中分布均匀，在动脉到动脉栓塞患者的MCA远端更常见，在局部分支闭塞患者的MCA中部更常见。最大WSS和斑块强化在无症状MCA动脉粥样硬化患者或局部分支闭塞患者的最小管腔区域更突出，在动脉到动脉栓塞患者的上游区域更突出。最大WSS的升高变异性与动脉到动脉栓塞所致卒中有关。
动脉到动脉栓塞所致卒中与斑块强化以及斑块上游点的最高最大WSS有关，并且与最大WSS的升高变异性相关。
