Men Xuejiao, Hu Mengyan, Guo Zhuoxin, Li Yu, Zheng Lu, Wu Ruizhen, Huang Xuehong, Zhang Bingjun, Lu Zhengqi
Department of Neurology, Mental and Neurological Disease Research Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Cerebrovasc Dis. 2024;53(1):88-97. doi: 10.1159/000530371. Epub 2023 Mar 30.
Intracranial branch atheromatous disease (BAD) has been applied to occlusions that occur at the origin of large caliber penetrating arteries due to the microatheromas or large parent artery plaques. This study aimed to explore the association between culprit plaques of large parent arteries, neuroimaging markers of cerebral small vessel disease (CSVD), and the risk of early neurological deterioration (END) in stroke patients with BAD.
A total of 97 stroke patients with BAD in the vascular territories of the lenticulostriate arteries or paramedian pontine arteries, diagnosed using high-resolution magnetic resonance imaging, were prospectively recruited in this observational study. A culprit plaque in the middle cerebral artery was defined as the only arterial plaque on the ipsilateral side of an infarction visible on diffusion-weighted imaging. A culprit plaque in the basilar artery (BA) was identified when it was observed within the same axial slices of an infarction or on the adjacent upper or lower slice, whereas a plaque within the BA located in the ventral region was considered non-culprit. If more than one plaque was present in the same vascular territory, the most stenotic plaque was chosen for the analysis. Four CSVD neuroimaging markers, including white matter hyperintensity, lacunes, microbleeds, and enlarged perivascular spaces, were evaluated in accordance with the total CSVD score. The associations between neuroimaging features of lesions within large parent arteries, neuroimaging markers of CSVD, and the risk of END in stroke patients with BAD were investigated using logistic regression analysis.
END occurred in 41 stroke patients (42.27%) with BAD. The degree of large parent artery stenosis (p < 0.001), culprit plaques of large parent arteries (p < 0.001), and plaque burden (p < 0.001) were significantly different between the END and non-END groups in stroke patients with BAD. In logistic regression analysis, culprit plaques of large parent arteries (odds ratio, 32.258; 95% confidence interval, 4.140-251.346) were independently associated with the risk of END in stroke patients with BAD.
Culprit plaques of large parent arteries could predict the risk of END in stroke patients with BAD. These results suggest that lesions in the large parent arteries, rather than damage to the cerebral small vessels, contribute to END in stroke patients with BAD.
颅内分支动脉粥样硬化疾病（BAD）已被用于描述因微动脉粥样硬化或大的母动脉斑块导致的大口径穿支动脉起始处的闭塞。本研究旨在探讨大母动脉的罪犯斑块、脑小血管疾病（CSVD）的神经影像学标志物与BAD中风患者早期神经功能恶化（END）风险之间的关联。
本观察性研究前瞻性纳入了97例经高分辨率磁共振成像诊断为豆纹动脉或脑桥旁正中动脉血管区域BAD的中风患者。大脑中动脉的罪犯斑块定义为在扩散加权成像上可见的梗死同侧唯一的动脉斑块。当在梗死的同一轴位切片或相邻的上、下切片中观察到基底动脉（BA）的斑块时，将其确定为罪犯斑块，而位于BA腹侧区域的斑块则被视为非罪犯斑块。如果在同一血管区域存在多个斑块，则选择最狭窄的斑块进行分析。根据总CSVD评分评估四种CSVD神经影像学标志物，包括白质高信号、腔隙、微出血和血管周围间隙扩大。采用逻辑回归分析研究大母动脉内病变的神经影像学特征、CSVD的神经影像学标志物与BAD中风患者END风险之间的关联。
97例BAD中风患者中有41例（42.27%）发生了END。BAD中风患者的END组和非END组之间，大母动脉狭窄程度（p<0.001）、大母动脉的罪犯斑块（p<0.001）和斑块负荷（p<0.001）存在显著差异。在逻辑回归分析中，大母动脉的罪犯斑块（优势比，32.258；95%置信区间，4.140 - 251.346）与BAD中风患者的END风险独立相关。
大母动脉的罪犯斑块可预测BAD中风患者的END风险。这些结果表明，在BAD中风患者中，大母动脉的病变而非脑小血管的损伤导致了END。
