Mechanism of Ischemic Infarct in Spontaneous Cervical Artery Dissection
Mechanism of Ischemic Infarct in Spontaneous Cervical Artery Dissection
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DOI：
10.1161/strokeaha.111.643338
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发表时间：
2012-05-01
期刊：
影响因子：
8.3
通讯作者：
Oppenheim, Catherine
中科院分区：
文献类型：
--
作者：
Morel, Audrey;Naggara, Olivier;Oppenheim, Catherine
背景和目的——尚不清楚自发性颈动脉夹层（CAD）患者的中风是由于继发性血栓栓塞还是由于原发性颈动脉病变的脑血流量减少所致。本研究的目的是利用 CAD 患者的颈椎和脑部影像参数来确定最可能的中风机制。方法——该研究得到了当地伦理委员会的批准。放弃知情同意。我们回顾性评估了连续 CAD 患者的脑血管超声、颈部 MR 血管造影和卒中脑 MRI。在 T2* 上直接可视化颅内栓塞作为易感性血管征的情况下，或者在扩散加权成像上出现软脑膜动脉区域梗塞的情况下，考虑栓塞机制。当分水岭梗塞和分水岭梗塞与软脑膜动脉梗塞相关时，当存在≥2种以下情况时，应考虑血流动力学机制：严重狭窄或闭塞性CAD、脑血管超声上颅内速度降低或MR血管造影上信号降低、或液体衰减反转恢复时出现高信号血管征。其余患者被认为具有混合机制。 结果 - 在 172 名连续患有 CAD 的患者中，弥散加权成像显示 100 名 (58%) 患有急性中风。 100 名患者中 85 名患者中风归因于血栓栓塞机制，100 名患者中 12 名中风归因于血流动力学机制，100 名患者中 3 名中风归因于混合机制。 结论：CAD 患者中风最常与影像学上动脉间栓塞的直接和间接征象相关，这一发现应有助于设计未来的治疗试验。 （中风。2012；43：1354-1361。）
Background and Purpose-It is unclear whether strokes in patients with spontaneous cervical artery dissection (CAD) are due to secondary thromboembolism or to a reduction in cerebral blood flow from the primary cervical lesion. The aim of this study was to identify the most likely mechanism of stroke using cervical and cerebral imaging parameters in patients with CAD.Methods-The study was approved by the local Ethics Committee. Informed consent was waived. We retrospectively evaluated the cerebrovascular ultrasound, cervical MR angiography, and stroke brain MRI in consecutive patients with CAD. An embolic mechanism was considered in the case of direct visualization of an intracranial embolism as a susceptibility vessel sign on T2* or in the case of pial artery territory infarction on diffusion-weighted imaging. A hemodynamic mechanism was considered in the case of watershed infarction and in the case of an association of watershed infarction and pial artery territory infarction when >= 2 of the following were present: severe stenotic or occlusive CAD, reduced intracranial velocity on cerebrovascular ultrasound or signal on MR angiography, or hyperintense vessel sign on fluid-attenuated inversion recovery. The remaining patients were considered to have a mixed mechanism.Results-Of 172 consecutive patients with CAD, 100 (58%) had acute stroke on diffusion-weighted imaging. Stroke was attributed to a thromboembolic mechanism in 85 of 100 patients, a hemodynamic mechanism in 12 of 100 patients, and a mixed mechanism in 3 of 100 patients.Conclusions-Stroke in patients with CAD is most frequently associated with both direct and indirect signs of artery-to-artery embolization on imaging, a finding that should help design future therapeutic trials. (Stroke. 2012;43:1354-1361.)