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目的探讨颅内外动脉并发狭窄导致的脑梗死的模式。方法用CT血管成像(CTA)检测185例急性脑梗死患者的颅内外动脉的狭窄情况;MR弥散加权成像(DWI)检查确定患者的脑梗死模式:单发或多发性脑梗死,穿动脉梗死(PAI)、皮质支梗死(PI)、分水岭梗死(BZI)、大面积脑梗死。比较并发狭窄与非并发狭窄患者的脑梗死模式。结果 CTA示颅内外动脉并发狭窄69例,其中串联狭窄49例、非串联狭窄20例;非并发狭窄99例;无狭窄17例。颅内外动脉并发狭窄组的多发性脑梗死、PAI+PI+BZI的比率(55.1%,20.3%)显著高于非并发狭窄组(34.3%,5.1%)(均P<0.01);而单发小PAI的比率(24.6%)显著低于非并发狭窄组(48.5%)(P<0.01)。并发狭窄组中串联狭窄亚组的多发性脑梗死(65.3%)及PAI+PI+BZI(26.5%)的比率显著高于非串联狭窄亚组(30%,5%)(P<0.05～0.01);而单发小PAI的比率(14.3%)显著低于非串联狭窄亚组(50.0%)(P<0.01)。结论颅内外动脉并发狭窄导致的脑梗死以多发性梗死及PAI+PI+BZI的模式多见。
Objective To explore the pattern of cerebral infarction caused by intracranial and extracranial arterial stenosis. Methods CT angiography (CTA) was used to detect the extracranial and extracranial arterial stenosis in 185 patients with acute cerebral infarction. MR diffusion weighted imaging (DWI) examination was used to determine the pattern of cerebral infarction in patients with single or multiple cerebral infarction and percutaneous arterial infarction PAI), cortical branch infarction (PI), watershed infarction (BZI), large area cerebral infarction. Compare the pattern of cerebral infarction in patients with and without stenosis. Results CTA showed intracranial and extracranial arterial stenosis in 69 cases, including 49 cases of series stenosis, 20 cases of non-series stenosis; 99 cases of non-complicated stenosis; 17 cases without stenosis. The rates of PAI + PI + BZI (55.1%, 20.3%) in patients with intracranial and extracranial arterial stenosis were significantly higher than those in nonsurgical group (34.3% vs 5.1%, P <0.01) The rate of small PAI (24.6%) was significantly lower than that of non-concurrent stenosis (48.5%) (P <0.01). The incidence of multiple cerebral infarction (65.3%) and PAI + PI + BZI (26.5%) in the in-stenosis group in the series stenosis subgroup was significantly higher than that in the non-tandem stenosis subgroup (30%, 5% ), While the rate of single small PAI (14.3%) was significantly lower than that of non-tandem stenosis (50.0%) (P <0.01). Conclusions Cerebral infarction caused by intracranial and extracranial arterial stenosis is more common with multiple infarcts and PAI + PI + BZI patterns.