Mast H, Thompson J L, Völler H, Mohr J P, Marx P
Neurovascular Unit, Columbia Presbyterian Hospital, New York, NY 10032.
Stroke. 1994 Apr;25(4):776-81. doi: 10.1161/01.str.25.4.776.
On the assumption that the majority of lacunes are caused by small-vessel diseases and that pial artery infarcts arise from cardio-embolic or large-vessel diseases, 194 patients from the Berlin Cerebral Ischemia Data Bank with either lacunar or pial artery infarcts were analyzed for the frequency of cardiac sources of embolism. The primary hypothesis was that the frequency of cardiac sources of embolism is higher among pial artery infarct subjects.
The presence of cardiac sources of embolism was estimated by electrocardiographic and transthoracic and transesophageal echocardiographic studies. Cranial computed tomography scans were evaluated by two masked observers.
The overall rate of cardiac sources of embolism did not differ significantly between the lacunar and the pial artery infarct group (66% versus 71%; odds ratio, 0.80; confidence interval, 0.43 to 1.50). Echocardiographic evidence of cardiac thrombi was positively associated with pial artery infarcts (odds ratio, 0.18; confidence interval, 0.04 to 0.80); atrial fibrillation and all other cardiac sources were not.
Left cardiac thrombi are significantly associated with pial artery infarcts. Other presumed cardiac sources of embolism, including atrial fibrillation, may often represent coincidental findings or have a less strong tendency to result in pial artery infarcts.
基于多数腔隙性脑梗死由小血管疾病引起，而软脑膜动脉梗死由心源性或大血管疾病所致这一假设，对柏林脑缺血数据库中194例患有腔隙性或软脑膜动脉梗死的患者进行了心脏栓塞源频率分析。主要假设是软脑膜动脉梗死患者中心脏栓塞源的频率更高。
通过心电图、经胸和经食管超声心动图检查评估心脏栓塞源的存在情况。由两名不知情的观察者对头颅计算机断层扫描进行评估。
腔隙性脑梗死组和软脑膜动脉梗死组的心脏栓塞源总体发生率无显著差异（分别为66%和71%；优势比为0.80；可信区间为0.43至1.50）。心脏血栓的超声心动图证据与软脑膜动脉梗死呈正相关（优势比为0.18；可信区间为0.04至0.80）；房颤和所有其他心脏栓塞源则不然。
左心血栓与软脑膜动脉梗死显著相关。其他假定的心脏栓塞源，包括房颤，可能常为偶然发现，或导致软脑膜动脉梗死的倾向较弱。
