TY - JOUR
T1 - Pathophysiology of acute cerebrovascular syndrome in patients with carotid artery stenosis
T2 - A magnetic resonance imaging/single-photon emission computed tomography study
AU - Kashiwazaki, Daina
AU - Akioka, Naoki
AU - Kuwayama, Naoya
AU - Noguchi, Kyo
AU - Tanaka, Kortaro
AU - Kuroda, Satoshi
N1 - Publisher Copyright:
© 2015 by the Congress of Neurological Surgeons.
PY - 2015/4/19
Y1 - 2015/4/19
N2 - Background: The mechanisms underlying acute cerebrovascular syndrome in patients with carotid artery stenosis remain unclear. Objective: To assess the relationships among infarct localization, hemodynamics, and plaque components. Methods: This prospective study included 38 patients with acute cerebrovascular syndrome resulting from ipsilateral carotid artery stenosis. Cerebral infarct localization was categorized into 3 patterns (cortical, border zone, and mixed pattern). Carotid plaque components were evaluated with T1-weighted magnetic resonance imaging and time-of-flight imaging. Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) were also quantified. Results: Infarcts were identified in 38 patients with the use of diffusion-weighted magnetic resonance imaging. On the basis of the assessment of hemodynamics, the cortical pattern was seen in 18 of 21 patients with type 1 ischemia (normal CBF, normal CVR), whereas the mixed pattern was seen in 2 patients with type 2 ischemia (normal CBF, impaired CVR) and 12 of 15 patients with type 3 ischemia (impaired CBF, impaired CVR). The plaque components were categorized into fibrous (4 patients), lipid-rich (14 patients), and intraplaque hemorrhage (IPH; 20 patients). Of the patients with fibrous plaque, 2 had border-zone and 2 had mixed-pattern infarcts. Of the patients with lipid-rich plaque, 7 had cortical and 6 had mixed-pattern infarcts. Of patients with intraplaque hemorrhage, 11 had cortical and 9 had mixed-pattern infarcts. Conclusion: Cortical infarction occurs as a result of vulnerable plaque. Reduced cerebral perfusion induces border-zone infarction. Both factors are implicated in mixed-pattern infarction. Developments in noninvasive diagnostic modalities allow us to explore the mechanisms behind acute cerebrovascular syndrome in carotid artery stenosis and to determine the ideal therapies.
AB - Background: The mechanisms underlying acute cerebrovascular syndrome in patients with carotid artery stenosis remain unclear. Objective: To assess the relationships among infarct localization, hemodynamics, and plaque components. Methods: This prospective study included 38 patients with acute cerebrovascular syndrome resulting from ipsilateral carotid artery stenosis. Cerebral infarct localization was categorized into 3 patterns (cortical, border zone, and mixed pattern). Carotid plaque components were evaluated with T1-weighted magnetic resonance imaging and time-of-flight imaging. Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) were also quantified. Results: Infarcts were identified in 38 patients with the use of diffusion-weighted magnetic resonance imaging. On the basis of the assessment of hemodynamics, the cortical pattern was seen in 18 of 21 patients with type 1 ischemia (normal CBF, normal CVR), whereas the mixed pattern was seen in 2 patients with type 2 ischemia (normal CBF, impaired CVR) and 12 of 15 patients with type 3 ischemia (impaired CBF, impaired CVR). The plaque components were categorized into fibrous (4 patients), lipid-rich (14 patients), and intraplaque hemorrhage (IPH; 20 patients). Of the patients with fibrous plaque, 2 had border-zone and 2 had mixed-pattern infarcts. Of the patients with lipid-rich plaque, 7 had cortical and 6 had mixed-pattern infarcts. Of patients with intraplaque hemorrhage, 11 had cortical and 9 had mixed-pattern infarcts. Conclusion: Cortical infarction occurs as a result of vulnerable plaque. Reduced cerebral perfusion induces border-zone infarction. Both factors are implicated in mixed-pattern infarction. Developments in noninvasive diagnostic modalities allow us to explore the mechanisms behind acute cerebrovascular syndrome in carotid artery stenosis and to determine the ideal therapies.
KW - Carotid artery stenosis
KW - Magnetic Resonance Imaging
KW - Mechanisms
KW - Single-Photon Emission Tomography
UR - http://www.scopus.com/inward/record.url?scp=84925137004&partnerID=8YFLogxK
U2 - 10.1227/NEU.0000000000000655
DO - 10.1227/NEU.0000000000000655
M3 - 学術論文
C2 - 25621983
AN - SCOPUS:84925137004
SN - 0148-396X
VL - 76
SP - 427
EP - 433
JO - Neurosurgery
JF - Neurosurgery
IS - 4
ER -