皮层和内部分水岭梗死可能是预测轻度症状颈内动脉闭塞患者神经功能恶化的关键标志。

IF 2 Q3 PERIPHERAL VASCULAR DISEASE Cerebrovascular Diseases Extra Pub Date : 2020-01-01 Epub Date: 2020-07-29 DOI:10.1159/000508090
Yuki Amano, Hiroyasu Sano, Ayataka Fujimoto, Hiroaki Kenmochi, Haruhiko Sato, Soichi Akamine
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引用次数: 6

摘要

背景:症状轻微的大血管闭塞(LVO)引起的急性缺血性脑卒中的治疗正在讨论中。虽然大多数患者预后良好,但也有一些患者病情恶化,结果不佳。需要影像学结果预测轻度LVO的预后,以确定需要治疗的患者。在这项研究中,我们关注分水岭梗死(WSIs),因为这种临床现象非常敏感地反映了脑血流的变化。本研究的目的是评估颈内动脉(ICA)闭塞患者MRI表现中WSI的阳性率,并比较不同临床病程患者间WSI阳性率的差异。方法:回顾性收集2006年6月至2019年7月期间1531例急性缺血性卒中患者的资料。其中,我们选择了有房颤病史的症状性ICA闭塞患者,并对其进行保守治疗。我们将这些患者分为两组,一组住院后NIHSS评分维持或改善,另一组NIHSS评分恶化。比较两组间wsi阳性率。结果:1531例患者中有37例纳入本研究。其中8例(A组)患者NIHSS总评分维持或改善,其中3例(37.5%)发生内分水岭梗死(IWIs)。在B组,NIHSS评分在症状出现后7天恶化>2的患者中,24例(82.8%)有IWIs。A组IWI阳性率低于B组(p = 0.02)。A组3例(37.5%)出现皮质分水岭梗死(cwi), B组27例(93.1%)出现cwi。A组CWI阳性率明显低于B组(p = 0.002)。结论:在轻度症状性ICA闭塞患者中,cwi和iwi可能是预测住院后神经系统恶化的关键指标。
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Cortical and Internal Watershed Infarcts Might Be Key Signs for Predicting Neurological Deterioration in Patients with Internal Carotid Artery Occlusion with Mild Symptoms.

Background: Treatment for acute ischemic stroke due to large vessel occlusion (LVO) with mild symptoms is under discussion. Although most patients have good outcomes, some patients deteriorate and have unfavorable results. Imaging findings that predict the prognosis of LVO with mild symptoms are needed to identify patients who require treatment. In this study, we focused on watershed infarctions (WSIs), because this clinical phenomenon quite sensitively reflects changes in cerebral blood flow. The purpose of this study was to assess positive rates of WSI on MRI findings in patients with internal carotid artery (ICA) occlusion, and compare WSI-positive rates between patients divided according to their clinical course.

Methods: We retrospectively collected data of 1,531 patients who presented with acute ischemic stroke between June 2006 and July 2019. Among them, we chose symptomatic ICA occlusion patients with a past history of atrial fibrillation who were treated conservatively. We divided these patients into two groups, those with maintenance or improvement in their NIHSS score after hospitalization, and those whose NIHSS score worsened. We compared WSI-positive rates between these two groups.

Results: Thirty-seven of the 1,531 patients were included in this study. Of them, total NIHSS score was maintained or improved in 8 patients (group A), 3 of whom (37.5%) had internal watershed infarctions (IWIs). In group B, consisting of patients whose NIHSS score worsened by >2 at 7 days from symptom onset, 24 (82.8%) had IWIs. Group A thus had statistically lower IWI positivity rates than group B (p = 0.02). Three patients (37.5%) in group A had cortical watershed infarctions (CWIs), while 27 patients in group B (93.1%) had CWIs. Group A thus had a significantly lower CWI positivity rate than group B (p = 0.002).

Conclusion: In patients with mildly symptomatic ICA occlusion, CWIs and IWIs might be key signs for predicting neurological deterioration after hospitalization.

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来源期刊
Cerebrovascular Diseases Extra
Cerebrovascular Diseases Extra PERIPHERAL VASCULAR DISEASE-
CiteScore
3.50
自引率
0.00%
发文量
16
审稿时长
8 weeks
期刊介绍: This open access and online-only journal publishes original articles covering the entire spectrum of stroke and cerebrovascular research, drawing from a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. Offering an international forum, it meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues. The journal publishes original contributions, reviews of selected topics as well as clinical investigative studies. All aspects related to clinical advances are considered, while purely experimental work appears only if directly relevant to clinical issues. Cerebrovascular Diseases Extra provides additional contents based on reviewed and accepted submissions to the main journal Cerebrovascular Diseases.
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