Selective Vulnerability of Cortical Border Zone to Microembolic Infarct
Selective Vulnerability of Cortical Border Zone to Microembolic Infarct
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DOI：
10.1161/strokeaha.114.008194
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发表时间：
2015-07-01
期刊：
影响因子：
8.3
通讯作者：
Gaita, Fiorenzo
中科院分区：
文献类型：
--
作者：
Bergui, Mauro;Castagno, Davide;Gaita, Fiorenzo
背景和目的血管内手术，包括心房颤动经导管消融术，可能导致脑动脉微栓塞。微栓子常引起小体积和临床上无症状的脑缺血（SCI）。这些病变在术后早期磁共振弥散加权像上清晰可见。我们分析了SCI的分布在提交给房颤transcatheter ablation.Methods连续927例房颤transcatheter ablation患者中的78例在术后磁共振检查中发现急性SCI阳性。识别并标记SCI，并将其坐标从本地空间转换为International Consortium for Brain Mapping/Montreal Neurological Institute空间。然后，我们使用激活似然估计approximates.Results SCI更常见于大脑皮层的体素的概率分布图计算。在幕上区域，SCI选择性地涉及大脑前、中、后动脉之间的皮质边界区;在幕下区域，小脑后下动脉的远端区域。可能的解释包括选择性栓塞，与供应这些区域的软脑膜动脉的血管解剖结构有关，在相对低灌注区减少了栓子的清除，或两者兼而有之。这种特殊的分布病变已报告在两种动物模型和患者与微栓子的不同sources.Conclusions一个选择性的脆弱性皮质边缘区发生在心房颤动经导管消融微栓子观察。我们假设这种选择性可能适用于不同来源的微栓子。
Background and Purpose Endovascular procedures, including atrial fibrillation transcatheter ablation, may cause microembolization of brain arteries. Microemboli often cause small sized and clinically silent cerebral ischemias (SCI). These lesions are clearly visible on early postoperative magnetic resonance diffusion-weighted images. We analyzed SCI distribution in a population of patients submitted to atrial fibrillation transcatheter ablation.Methods Seventy-eight of 927 consecutive patients submitted to atrial fibrillation transcatheter ablation were found positive for acute SCI on a postoperative magnetic resonance. SCI were identified and marked, and their coordinates were transformed from native space into the International Consortium for Brain Mapping/Montreal Neurological Institute space. We then computed the voxel-wise probability distribution map of the SCI using the activation likelihood estimation approach.Results SCI were more commonly found in the cortex. In supratentorial regions, SCI selectively involved cortical border zone between anterior, middle, and posterior cerebral arteries; in infratentorial regions, distal territory of posteroinferior cerebellar artery. Possible explanations include selective embolization, linked to the vascular anatomy of pial arteries supplying those territories, reduced clearance of emboli in a relatively hypoperfused zone, or a combination of both. This particular distribution of lesions has been reported in both animal models and in patients with microemboli of different sources.Conclusions A selective vulnerability of cortical border zone to microemboli occurring during atrial fibrillation transcatheter ablation was observed. We hypothesize that such selectivity may apply to microemboli of different sources.