Gandolfo C, Del Sette M, Finocchi C, Calautti C, Loeb C
Stroke Unit, Department of Neurosciences and Neurorehabilitation, University of Genoa, Italy.
Cerebrovasc Dis. 1998 Sep-Oct;8(5):255-8. doi: 10.1159/000015862.
The mechanism underlying cerebral infarction in the borderzone between the territories of deep and superficial perforating arteries has not yet been clarified. This study was performed to investigate the prevalence, volume, site, and etiology of this type of subcortical infarction in a large unselected group of stroke patients.
We analyzed a continuous series of 383 patients with recent cerebral infarction observed in our Stroke Unit. Patients underwent a complete clinical and instrumental workup. The subgroup of subjects with internal borderzone infarct alone were compared with the subgroups of patients with other types of cerebral infarcts by uni- and multivariate statistical tests.
There were 90 internal borderzone infarcts of 725 ischemic lesions (12%of the total), with a median volume of 0.32 ml (95% confidence interval 0.24-0.44; range: 0.012- 20.2 ml). Internal borderzone infarcts alone occurred in only 13 of 383 (3.4%) patients. A comparison between patients with 'pure' internal borderzone infarction and patients with other types of cerebral infarcts by multiple logistic regression analysis demonstrated a significant independent causal role of carotid stenosis or occlusion.
Our study suggests that 'pure' internal borderzone infarctions are quite rare findings in patients with ischemic stroke, and that the hemodynamic impairment due to atherosclerotic occlusion or stenosis of the carotid system could be the cause in the large majority of cases.
大脑深部和浅部穿支动脉供血区之间边缘带脑梗死的潜在机制尚未阐明。本研究旨在调查一大组未经选择的卒中患者中此类皮质下梗死的患病率、体积、部位和病因。
我们分析了在我们的卒中单元连续观察的383例近期脑梗死患者。患者接受了全面的临床和器械检查。通过单变量和多变量统计检验，将仅患有内边缘带梗死的患者亚组与其他类型脑梗死患者的亚组进行比较。
在725个缺血性病变中有90个内边缘带梗死（占总数的12%），中位体积为0.32毫升（95%置信区间0.24 - 0.44；范围：0.012 - 20.2毫升）。仅383例患者中有13例（3.4%）发生了单纯的内边缘带梗死。通过多因素logistic回归分析比较“单纯”内边缘带梗死患者与其他类型脑梗死患者，结果显示颈动脉狭窄或闭塞具有显著的独立因果作用。
我们的研究表明，“单纯”内边缘带梗死在缺血性卒中患者中是相当罕见的发现，并且在大多数情况下，颈动脉系统动脉粥样硬化闭塞或狭窄导致的血流动力学损害可能是其病因。
