Liu Yang, Wang Lihua, Fu Kuang, Kong Xiaotong, Guo Wenhui, Wang Ning, Sun Xuesong, Cai Hanlu, Yu Yan, Zhang Zhaobo, Zou Xingbang, Cao Ying, Luo Doudou, Liu Peifang
Department of Neurology, the Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150000, China.
Department of MRI Diagnosis, the Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150000, China.
J Stroke Cerebrovasc Dis. 2025 Feb;34(2):108210. doi: 10.1016/j.jstrokecerebrovasdis.2024.108210. Epub 2024 Dec 20.
Branch atheromatous disease (BAD) is prone to early neurological deterioration (END), leading to a poor prognosis. The most common arteries causing END are the lenticulostriate arteries (LSA) and the paramedian pontine arteries (PPA). To gain insight into the characteristics of symptomatic plaques and their association with poor prognosis in patients with BAD, we conducted a prospective study using high-resolution magnetic resonance imaging (HRMRI).
A total of 75 patients with BAD in the vascular range of LSA or PPA were recruited for this study. The vascular and plaque features of the carrier middle cerebral artery (MCA) and basilar artery (BA) were evaluated through the application of HRMRI, and the local cerebral blood flow (CBF) of the lesion was assessed through pseudo-continuous arterial spin-labeling (pCASL), and the number and location of cerebral microbleeds (CMBs) were documented by susceptibility-weighted imaging (SWI). Univariable and multivariable logistic regression analyses were performed to analyze the factors that affected the prognosis.
A poor prognosis was observed in 24 patients (32%) with BAD. A total of 28 patients (37%) developed END. Multifactorial analysis showed statistically significant differences in the dorsal plaque of BA (OR: 19.15, 95% CI 1.72-385.37, p=0.028), male (OR: 26.22, 95% CI 3.18-406.31, p=0.007), and NIHSS at 7 days of onset (OR: 2.24, 95% CI 1.4-4.45, p=0.004).
In patients with BAD in LSA and PPA areas, the dorsal plaque of BA, male, and NIHSS at 7 days of onset were independent risk factors for poor prognosis.
分支动脉粥样硬化疾病（BAD）易导致早期神经功能恶化（END），预后较差。导致END最常见的动脉是豆纹动脉（LSA）和脑桥旁正中动脉（PPA）。为深入了解BAD患者症状性斑块的特征及其与预后不良的关系，我们使用高分辨率磁共振成像（HRMRI）进行了一项前瞻性研究。
本研究共纳入75例LSA或PPA血管范围内患有BAD的患者。通过应用HRMRI评估载瘤大脑中动脉（MCA）和基底动脉（BA）的血管和斑块特征，通过伪连续动脉自旋标记（pCASL）评估病变部位的局部脑血流量（CBF），并通过磁敏感加权成像（SWI）记录脑微出血（CMB）的数量和位置。进行单变量和多变量逻辑回归分析以分析影响预后的因素。
75例BAD患者中，24例（32%）预后较差。共有28例（37%）发生END。多因素分析显示，BA的背侧斑块（OR：19.15，95%CI 1.72 - 385.37，p = 0.028）、男性（OR：26.22，95%CI 3.18 - 406.31，p = 0.007）和发病7天时的美国国立卫生研究院卒中量表（NIHSS）评分（OR：2.24，95%CI 1.4 - 4.45，p = 0.004）存在统计学显著差异。
在LSA和PPA区域患有BAD的患者中，BA的背侧斑块、男性以及发病7天时的NIHSS评分是预后不良的独立危险因素。
