Kadooka Keisuke, Arakaki Yoshito, Kikuchi Yoichi, Mitsutake Takafumi, Tanaka Michihiro, Tanaka Tatsuya, Yamane Fumitaka, Matsuno Akira
Department of Neuroendovascular Surgery, Kameda Medical Center, Kamogawa, JPN.
Department of Neurosurgery, International University of Health and Welfare Graduate School, Narita, JPN.
Cureus. 2024 Dec 15;16(12):e75775. doi: 10.7759/cureus.75775. eCollection 2024 Dec.
Background In treating acute ischemic stroke (AIS), asymmetrical vein signs (AVS) on blood-oxygen-level-dependent imaging reflect increased deoxyhemoglobin levels due to increased oxygen extraction fraction. Meanwhile, although veins connecting pial and deep venous systems, such as transcerebral veins, are well studied, dynamic observation of these veins remains challenging. This study aimed to elucidate the venous flow of the deep white matter (DWM), focusing on medullary AVS in patients with hyperacute cardioembolic M1 occlusion. Methods This retrospective cross-sectional study involved 50 patients with AIS caused by M1 occlusion who received mechanical thrombectomy at Kameda Medical Center from July 2018 to December 2021. The study investigated medullary AVS and their association with angiographic collateral flow grades and occlusion locations. Welch's t-test was used for continuous variables, while Fisher's exact test was employed for categorical variables. Results A total of 41 patients were eligible for analysis. No significant association was found between medullary AVS and angiographic collateral flow grade (p=1.000); however, a significant association was observed between proximal M1 occlusion and medullary AVS (p=0.006), supporting the hypothesis that medullary AVS is significantly influenced by ischemic conditions in the territory of lenticulostriate arteries. Conclusion Three possible mechanisms for medullary AVS were considered: local ischemia in the DWM, ventriculopetal ischemic venous flow from the pial veins, and ventriculofugal ischemic venous flow from the basal ganglia. The results of the present study and the fact that the DWM is exclusively perfused by the cortical arteries favor the ventriculofugal flow hypothesis as the mechanism of medullary AVS. Although direct observation of the veins in the DWM by cerebral angiography is challenging, it can be deduced indirectly.
背景 在治疗急性缺血性卒中（AIS）时，血氧水平依赖成像上的不对称静脉征（AVS）反映了由于氧摄取分数增加导致的脱氧血红蛋白水平升高。同时，尽管连接软脑膜和深部静脉系统的静脉，如经脑静脉，已得到充分研究，但对这些静脉的动态观察仍然具有挑战性。本研究旨在阐明超急性心源性栓塞性M1段闭塞患者深部白质（DWM）的静脉血流，重点关注髓质AVS。方法 这项回顾性横断面研究纳入了2018年7月至2021年12月在镰田医疗中心接受机械取栓治疗的50例由M1段闭塞引起的AIS患者。该研究调查了髓质AVS及其与血管造影侧支血流分级和闭塞部位的关系。连续变量采用韦尔奇t检验，分类变量采用费舍尔精确检验。结果 共有41例患者符合分析条件。未发现髓质AVS与血管造影侧支血流分级之间存在显著关联（p = 1.000）；然而，观察到近端M1段闭塞与髓质AVS之间存在显著关联（p = 0.006），支持了髓质AVS受豆纹动脉供血区域缺血情况显著影响的假设。结论 考虑了髓质AVS的三种可能机制：DWM局部缺血、来自软脑膜静脉的向心性缺血静脉血流以及来自基底节的离心性缺血静脉血流。本研究结果以及DWM仅由皮质动脉供血这一事实支持了离心性血流假说是髓质AVS的机制。尽管通过脑血管造影直接观察DWM中的静脉具有挑战性，但可以间接推断。
