Ischemic stroke subtype classification: an asian viewpoint.
Ischemic stroke subtype classification: an asian viewpoint.
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DOI：
10.5853/jos.2014.16.1.8
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发表时间：
2014-01
影响因子：
8.2
通讯作者：
Kim JS
中科院分区：
文献类型：
--
作者：
Kim BJ;Kim JS
对脑卒中病因机制的正确分类对于优化脑卒中治疗和评估预后具有重要意义。卒中的主要病因因人种和种族而异：源自心脏或颅外大动脉的栓子在西方人群中很常见，而小血管闭塞或颅内动脉粥样硬化在亚洲人中更常见。颅内动脉粥样硬化常因分支动脉闭塞而导致卒中，这些病例的狭窄程度通常<50%。如果动脉粥样硬化斑块足够脆弱，轻度颅内动脉粥样硬化狭窄可引起远端栓塞。此外，高分辨率磁共振成像研究已经确定了导致梗死的小斑块，即使在血管表现正常的患者中也是如此。这种情况下，这是在亚洲普遍存在，不能被归类为大动脉粥样硬化以前的分类系统。此外，通常归因于脂透明质酸性小血管病的单一皮质下梗死可能有其他原因，包括穿支动脉微粥样硬化和载瘤动脉粥样硬化血栓病变。与载瘤动脉疾病相关的单一皮质下梗死或与主血管相邻的梗死比与穿通动脉脂透明变性相关的梗死更常具有动脉粥样硬化特征。在颅内动脉粥样硬化很常见的国家，这种动脉粥样硬化性单一皮质下梗死预计是普遍的。然而，这些案件在以前的制度中无法适当分类。应进一步努力制定缺血性卒中分类系统，充分结合最近的研究结果，并反映潜在的病理机制，特别是在单一的皮质下梗死和颅内动脉粥样硬化患者。
Proper classification of the causative mechanism of stroke is important for optimizing stroke treatment and assessing prognosis. The primary etiology of stroke differs according to race and ethnicity: emboli originating from the heart or extracranial large arteries are common in Western populations, whereas small-vessel occlusion or intracranial atherosclerosis is more prevalent in Asians. Intracranial atherosclerosis frequently leads to stroke by branch-artery occlusion, and the degree of stenosis in these cases is often <50%. Mild intracranial atherosclerotic stenosis may cause distal embolization, if the atherosclerotic plaque is sufficiently vulnerable. Moreover, high-resolution magnetic resonance imaging studies have identified small plaques causing infarction, even in patients with normal-appearing vascular findings. Such cases, which are prevalent in Asia, could not be classified as large-artery atherosclerosis by previous classification systems. Additionally, single subcortical infarctions, which are usually attributed to lipohyalinotic small-vessel disease, can have other causes, including microatheroma of perforators and atherothrombotic lesions at the parental artery. Single subcortical infarctions associated with parental artery disease or those bordering on the main vessel more often have atherosclerotic characteristics than do those associated with lipohyalinosis of the penetrating artery. In countries where intracranial atherosclerosis is common, such atherosclerotic single subcortical infarctions are predicted to be prevalent. These cases, however, could not be appropriately classified in previous systems. Further effort should be devoted to formulate ischemic stroke classification systems that adequately incorporate results of recent studies and reflect the underling pathologic mechanisms, especially in patients with single subcortical infarction and intracranial atherosclerosis.
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影响因子：
3.4
作者：
Gao S;Wang YJ;Xu AD;Li YS;Wang DZ
通讯作者：
Wang DZ
影响因子：
11.2
作者：
Ay, H;Furie, KL;Koroshetz, WJ
通讯作者：
Koroshetz, WJ
影响因子：
9.9
作者：
Arsava, E. M.;Ballabio, E.;Ay, H.
通讯作者：
Ay, H.
影响因子：
8.3
作者：
HOROWITZ, DR;TUHRIM, S;RUDOLPH, SH
通讯作者：
RUDOLPH, SH
影响因子：
8.3
作者：
Caplan, Louis R.
通讯作者：
Caplan, Louis R.