Evidence of misery perfusion and risk for recurrent stroke in major cerebral arterial occlusive diseases from PET
Evidence of misery perfusion and risk for recurrent stroke in major cerebral arterial occlusive diseases from PET
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DOI：
10.1136/jnnp.61.1.18
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发表时间：
1996-07-01
影响因子：
11
通讯作者：
Kimura, J
中科院分区：
文献类型：
--
作者：
Yamauchi, H;Fukuyama, H;Kimura, J
目的：在主要的脑动脉闭塞性疾病中，相对于代谢需求，血供不足的患者（痛苦灌注）可能会增加脑缺血的风险。本研究探讨了患者是否表现出痛苦的PET灌注有高风险的复发缺血性stroke. Methods-脑循环的区域血流动力学状态和随后的复发性中风的风险之间的关系进行了前瞻性评估，在40例有症状的颈内动脉或大脑中动脉闭塞性疾病谁接受PET。根据症状性疾病动脉供血半球的氧提取分数平均半球值，将患者分为两个血流动力学类别：氧提取分数正常的患者和氧提取分数增加的患者（痛苦灌注）。所有患者随访至少12 months.Results-the同侧缺血性中风的一年发病率与正常的氧提取分数和氧提取分数增加的患者分别为33例和4例7例。在氧摄取分数增加的患者中发现同侧卒中的发生率显著更高（Fisher精确检验; P=0.005）。在增加氧提取分数的患者中，四个中风分水岭梗死和TH，梗死的位置对应的面积增加氧提取fractions. Conclusion，这些研究结果相矛盾的结论，以前的研究表明，主要脑动脉闭塞性疾病和痛苦灌注的患者有高风险复发缺血性中风。
Objectives-In major cerebral arterial occlusive diseases, patients with inadequate blood supply relative to metabolic demand (misery perfusion) may be at increased risk for cerebral ischaemia. This study investigated whether patients showing misery perfusion on PET have a high risk of recurrent ischaemic stroke.Methods-The relation between the regional haemodynamic status of cerebral circulation and the subsequent risk of recurrent stroke was prospectively evaluated in 40 patients with symptomatic internal carotid or middle cerebral arterial occlusive diseases who underwent PET. Patients were divided into two haemodynamic categories according to the mean hemispheric value of oxygen extraction fraction in the hemisphere supplied by the artery with symptomatic disease: patients with normal oxygen extraction fraction and those with increased oxygen extraction fraction (misery perfusion). All patients were followed up for at least 12 months.Results-The one year incidence of ipsilateral ischaemic strokes for patients with normal oxygen extraction fraction and those with increased oxygen extraction fraction were two of 33 and four of seven patients respectively. A significantly higher incidence of ipsilateral strokes was found in patients with increased oxygen extraction fraction (Fisher's exact test; P=0.005). In patients with increased oxygen extraction fraction, three of four strokes were watershed infarctions and th, location of the infarction corresponded with the area of increased oxygen extraction fraction.Conclusion-These findings contradict conclusions of a previous study and suggest that patients with major cerebral arterial occlusive diseases and misery perfusion have a high risk for recurrent ischaemic stroke.