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目的探讨颈内动脉(ICA)系统狭窄或闭塞急性缺血性脑梗死(AICI)患者影像学病灶特点。方法 71例急性脑梗死患者,CT血管成像检查证实存在颈内动脉(ICA组,47例)或大脑中动脉(MCA组,24例)狭窄或闭塞,比较两组梗死病灶影像学特征。结果病灶模式包括弥散小梗死、皮质下梗死、分水岭梗死和区域性梗死四种。其中,ICA组分水岭梗死发生率高于MCA组(40.4%vs.12.5%)(P<0.05),皮质下梗死发生率低于MCA组(19.1%vs.50.0%)(P<0.05)。结论 ICA狭窄或闭塞性AICI患者以分水岭梗死多见,提示其发病机制可能以动脉-动脉栓塞合并低灌注-栓子清除能力下降为主;MCA狭窄或闭塞患者皮质下梗死较多见,提示其发病机制可能以动脉-动脉栓塞合并局部穿支闭塞为主。
Objective To investigate the imaging features of patients with stenosis or occlusion of acute ischemic cerebral infarction (AICI) in the internal carotid artery (ICA) system. Methods In 71 patients with acute cerebral infarction, CT angiography confirmed the presence of stenosis or occlusion in the internal carotid artery (ICA group, n = 47) or middle cerebral artery (MCA group, n = 24). The imaging features of the two groups were compared. Results The lesion pattern included diffuse small infarction, subcortical infarction, watershed infarction and regional infarction. Incidence of watershed infarction in ICA group was higher than that in MCA group (40.4% vs. 12.5%) (P <0.05), and the incidence of subcortical infarction was lower than that in MCA group (19.1% vs. 50.0%) (P <0.05). Conclusions The watershed infarction is more common in patients with ICA stenosis or occlusive AICI, suggesting that the pathogenesis of ICA may be mainly arterio-arterial embolization combined with hypoperfusion-embolectomy. The subcutaneous infarction in patients with MCA stenosis or occlusion is more common, suggesting that Pathogenesis may be arterial - arterial embolism combined with partial perforation occlusion based.