Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification and vascular territory of ischemic stroke lesions diagnosed by diffusion-weighted imaging.
Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification and vascular territory of ischemic stroke lesions diagnosed by diffusion-weighted imaging.
复制标题
ORG 10172在急性中风治疗（Toast）分类和血管区域的缺血性卒中病变和血管领域的试验。
DOI：
10.1161/jaha.114.001119
复制
发表时间：
2014-08-11
影响因子：
5.4
通讯作者：
Bae HJ
中科院分区：
文献类型：
--
作者：
Chung JW;Park SH;Kim N;Kim WJ;Park JH;Ko Y;Yang MH;Jang MS;Han MK;Jung C;Kim JH;Oh CW;Bae HJ
中风病变的位置和机制之间的联系尚不清楚。弥散加权成像研究可能有助于解决这种缺乏清晰度的问题。我们研究了2702例急性缺血性卒中患者的连续系列，这些患者的卒中病变经弥散加权成像证实，并接受了彻底的病因学调查。使用优势动脉区域的标准解剖图确定缺血性病变所在的血管区域。卒中亚型基于急性卒中治疗中的ORG 10172试验或吐司分类。大动脉粥样硬化（37.3%）是最常见的卒中亚型，大脑中动脉（49.6%）是最常累及的区域。大动脉粥样硬化是大脑前动脉、大脑中动脉、椎动脉以及小脑前下动脉和小脑后下动脉供血区梗死的最常见亚型。基底动脉和大脑后动脉区以小血管闭塞为主。小脑上上级动脉供血区的主要原因是脑栓塞。与颈动脉区卒中相比，椎基底动脉区卒中更容易由小血管闭塞引起（21.4%比30.1%，P<0.001），而较少由心源性栓塞引起（23.2%比13.8%，P<0.001）。多血管区梗死常由颈动脉区的心源性栓塞（44.2%）和椎基底动脉区的大动脉粥样硬化（52.1%）引起。脑卒中病灶血管分布的信息有助于及时调查和准确诊断脑卒中病因。
The association between the location and the mechanism of a stroke lesion remains unclear. A diffusion‐weighted imaging study may help resolve this lack of clarity. We studied a consecutive series of 2702 acute ischemic stroke patients whose stroke lesions were confirmed by diffusion‐weighted imaging and who underwent a thorough etiological investigation. The vascular territory in which an ischemic lesion was situated was identified using standard anatomic maps of the dominant arterial territories. Stroke subtype was based on the Trial of ORG 10172 in Acute Stroke Treatment, or TOAST, classification. Large‐artery atherosclerosis (37.3%) was the most common stroke subtype, and middle cerebral artery (49.6%) was the most frequently involved territory. Large‐artery atherosclerosis was the most common subtype for anterior cerebral, middle cerebral, vertebral, and anterior and posterior inferior cerebellar artery territory infarctions. Small vessel occlusion was the leading subtype in basilar and posterior cerebral artery territories. Cardioembolism was the leading cause in superior cerebellar artery territory. Compared with carotid territory stroke, vertebrobasilar territory stroke was more likely to be caused by small vessel occlusion (21.4% versus 30.1%, P<0.001) and less likely to be caused by cardioembolism (23.2% versus 13.8%, P<0.001). Multiple‐vascular‐territory infarction was frequently caused by cardioembolism (44.2%) in carotid territory and by large‐artery atherosclerosis (52.1%) in vertebrobasilar territory. Information on vascular territory of a stroke lesion may be helpful in timely investigation and accurate diagnosis of stroke etiology.