■颅内动脉狭窄(ICAS)和白质病变(WML)并存的中风患者通常预后较差。然而,WML如何影响卒中预后尚未确定.
■使用4D流量研究不同程度WML的ICAS患者大脑中动脉的定量正向流量。
■单中心横断面队列研究。
■包括有症状的大脑中动脉(MCA)动脉粥样硬化的缺血性卒中患者,根据Flair图像上的Fazekas量表将其分为2组(轻度组=Fazekas0-2,重度组=Fazekas>2),进行TOF-MRA和4D流,以量化狭窄程度和狭窄近端的前向流量。比较不同白质高强度(WMH)组之间的流量参数,以及在不同的MCA狭窄组中,使用逻辑回归来验证正向流和WMH之间的关联。
■本研究共纳入66例患者(平均年龄56岁,68.2%男性)。其中77.3%出现WMH(Fazekas1-5)。轻度和重度WMH组之间的流量指数比较发现向前流量显着降低(2.34±1.09vs3.04±1.35),更高的PI(0.75±0.43对0.66±0.32),重度WMH组同侧梗死MCARI(0.49±0.19vs0.46±0.15),所有P值<0.05。在调整其他协变量后,同侧梗死MCA的正向平均血流仍与严重WMH独立相关,OR=0.537,95%CI(0.294,0.981),P=0.043。
■合并严重WMH的颅内动脉狭窄患者流量明显下降,这可以解释这个人群的不良临床结果,并提供对未来再通治疗的一些见解。
为什么要做这项研究?颅内动脉狭窄(ICAS)的卒中患者的白质高信号(WMH)患病率很高,小血管疾病(SVD)的替代生物标志物,ICAS和WMH并存的患者更有可能出现不利的临床结局和更高的卒中复发风险.然而,WMH如何影响卒中结局尚不清楚.研究人员做了什么?在这项研究中,我们比较了不同WMH组之间的流量和灌注指数,以及在不同的ICAS组中使用4D流结合ASL,以获得该人群的数量流量关系。研究人员发现了什么?结果,我们发现颅内动脉狭窄程度和WMH负荷与血流减少有关,血流减少在梗死同侧更为显著。这是对ICAS和WMH并存的卒中患者使用4D血流联合ASL进行复杂血流动力学状态调查的第一项研究。这项研究的结果不仅可以为患有严重WMH负担的ICAS患者的不良临床结局提供一些证据,而且还可以使我们对该人群的再通治疗有所了解。
UNASSIGNED: Stroke patients with coexisting intracranial artery stenosis (ICAS) and white matter lesions (WML) usually have a poor outcome. However, how WML affects stroke prognosis has not been determined.
UNASSIGNED: To investigate the quantitative forward flow at the middle cerebral artery in ICAS patients with different degrees of WML using 4D flow.
UNASSIGNED: Single-center cross-sectional cohort study.
UNASSIGNED: Ischemic stroke patients with symptomatic middle cerebral artery (MCA) atherosclerosis were included, and they were divided into 2 groups based on Fazekas scale on Flair image (mild group = Fazekas 0-2, and severe group = Fazekas >2), TOF-MRA and 4D flow were performed to quantify the stenosis degree and forward flow at the proximal of stenosis. The flow parameters were compared between different white matter hyperintensity (WMH) groups, as well as in different MCA stenosis groups, logistic regression was used to validate the association between forward flow and WMH.
UNASSIGNED: A total of 66 patients were included in this study (mean age 56 years old, 68.2% male). 77.3% of them presented with WMH (Fazekas 1-5). Comparison of flow index between mild and severe WMH groups found a significantly lower forward flow (2.34 ± 1.09 vs 3.04 ± 1.35), higher PI (0.75 ± 0.43 vs 0.66 ± 0.32), and RI (0.49 ± 0.19 vs 0.46 ± 0.15) at ipsilateral infarction MCA in the severe WMH group, all P-values <0.05. After adjusting for other covariates, forward mean flow at ipsilateral infarction MCA is still associated with severe WMH independently, OR = 0.537, 95% CI (0.294, 0.981), P = 0.043.
UNASSIGNED: Intracranial artery stenosis patients with coexisting severe WMH suffer from significantly decreased flow, which could explain the poor clinical outcome in this population, and also provide some insight into recanalization therapy in the future.
Why was the study done? stroke patients with intracranial artery stenosis (ICAS) have a high prevalence of white matter hyperintensities (WMH), a surrogate biomarker of small vessel disease (SVD), and patients with coexisting ICAS and WMH are more likely to have unfavorable clinical outcomes and higher stroke recurrence risk. However, how WMH affects stroke outcomes has been unknown. What did the researchers do? In this study, we compared the flow and perfusion index between different WMH groups, as well as in different ICAS groups using 4D flow combined with ASL, to obtain the quantitative flow relationship in this population. What did the researchers find? As a result, we found that both the degree of intracranial artery stenosis and WMH burden is associated with decreased flow, and the flow decrease is more significant at the ipsilateral of infarct. What do the findings mean? This is the first study investigating the complicated hemodynamic status using 4D flow combined with ASL in stroke patients with coexisting ICAS and WMH. The results in this study could not only provide some evidence for unfavorable clinical outcomes in ICAS patients with severe WMH burden but also give us some insight into recanalization therapy in this population.