미세 색전 신호를 동반한 큰 동맥질환에서 확산강조영상의 병변 분석
Diffusion-weighted MRI Lesion Patterns in Large Artery Atherosclerotic Disease with Microembolic Signals
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Microembolic signals (MES) are associated with the pathogenic mechanism of ischemic stroke with large-artery atherosclerotic disease. We examined the relationship between MES on a transcranial Doppler ultrasonography (TCD) and lesion patterns on diffusion-weighted MR imaging (DWI) in acute ischemic strokes associated with atherosclerotic diseases of the middle cerebral artery (MCA) and internal carotid artery (ICA). Methods: A total of 405 consecutive patients were monitored for MES within 48 hours of symptom onset. Patients with MES and DWI lesions in the territory of the MCA or ICA and corresponding MCA/ICA stenosis or occlusion on MR angiography (MRA) were included. MCA velocities and lesion patterns on DWI were compared. Results: MES were detected in 25 patients (MCA: 13, ICA: 12). The mean number of MES during 30 minutes of monitoring was 14.2±17.3 (range: 1-64, MCA: 13.9±13.6, ICA: 14.5±21.6, p-value=0.098). The mean flow velocity in the ipsilateral MCA in patients with MCA disease was higher than in patients with ICA disease (129.9±74.4 cm/s vs 61.1±28.2 cm/s, p=0.006). The frequency of multiple lesions on DWI was higher inpatients with ICA disease than in those with MCA disease (46.1% vs 100%, p=0.003). Conclusions: Multiple lesions on DWI were more frequent in ICA disease with MES than in MCA disease. Artery-to-artery embolism may be a more important stroke mechanism in acute ischemic stroke with ICA disease.
Abstract
Background: Microembolic signals (MES) are associated with the pathogenic mechanism of ischemic stroke with large-artery atherosclerotic disease. We examined the relationship between MES on a transcranial Doppler ultrasonography (TCD) and lesion patterns on diffusion-weighted MR imaging (DWI) in acute ischemic strokes associated with atherosclerotic diseases of the middle cerebral artery (MCA) and internal carotid artery (ICA). Methods: A total of 405 consecutive patients were monitored for MES within 48 hours of symptom onset. Patients with MES and DWI lesions in the territory of the MCA or ICA and corresponding MCA/ICA stenosis or occlusion on MR angiography (MRA) were included. MCA velocities and lesion patterns on DWI were compared. Results: MES were detected in 25 patients (MCA: 13, ICA: 12). The mean number of MES during 30 minutes of monitoring was 14.2±17.3 (range: 1-64, MCA: 13.9±13.6, ICA: 14.5±21.6, p-value=0.098). The mean flow velocity in the ipsilateral MCA in patients with MCA disease was higher than in patients with ICA disease (129.9±74.4 cm/s vs 61.1±28.2 cm/s, p=0.006). The frequency of multiple lesions on DWI was higher inpatients with ICA disease than in those with MCA disease (46.1% vs 100%, p=0.003). Conclusions: Multiple lesions on DWI were more frequent in ICA disease with MES than in MCA disease. Artery-to-artery embolism may be a more important stroke mechanism in acute ischemic stroke with ICA disease.
참고문헌 (26)
- Feldmann E, "Chinese-white differences in the distribution of occlusive cerebrovascular disease", Neurology, 40, pp.1541~1545 (1990)
- Caplan LR, "Race, sex and occlusive cerebrovascular disease: a review", Stroke, 17, pp.648~655 (1986)
- Ley-Pozo J, "Noninvasive detection of occlusive disease of the carotid siphon and middle cerebral artery", Ann Neurol, 28, pp.640~647 (1990)
- Caplan L, "Occlusive disease of the middle cerebral artery", Neurology, 35, pp.975~982 (1985)
- Bogousslavsky J, "Atherosclerotic disease of the middle cerebral artery", Stroke, 17, pp.1112~1120 (1986)
- Tsiskaridze A, "Stroke with internal carotid artery stenosis", Arch Neurol, 58, pp.605~609 (2001)
- Kang DW, "Lesion patterns and mechanism of ischemia in internal carotid artery disease: a diffusion-weighted imaging study", Arch Neurol, 59, pp.1577~1582 (2002)
- Babikian VL, "Clinical correlates of high-intensity transient signals detected on transcranial Doppler sonography in patients with cerebrovascular disease", Stroke, 25, pp.1570~1573 (1994)
- Markus HS, "Differentiation between different pathological cerebral embolic materials using transcranial Doppler in an in vitro model", Stroke, 24, pp.1~5 (1993)
- Siebler M, "Cerebral microembolism in symptomatic and asymptomatic high- grade internal carotid artery stenosis", Neurology, 44, pp.615~618 (1994)
- Wong KS, "Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: a diffusion-weighted imaging and microemboli monitoring study", Ann Neurol, 52, pp.74~81 (2002)
- Gao S, "Microembolic signal predicts recurrent cerebral ischemic events in acute stroke patients with middle cerebral artery stenosis", Stroke, 35, pp.2832~2836 (2004)
- Lee PH, "Infarct patterns in atherosclerotic middle cerebral artery versus internal carotid artery disease", Neurology, 62, pp.1291~1296 (2004)
- Kimura K, "Microembolic signals and diffusion-weighted MR imaging abnormalities in acute ischemic stroke", AJNR Am J Neuroradiol, 22, pp.1037~1042 (2001)
- Markus HS, "Asymptomatic embolization detected by Doppler ultrasound predicts stroke risk in symptomatic carotid artery stenosis", Stroke, 36, pp.971~975 (2005)
- Ringelstein EB, "Consensus on microembolus detection by TCD. International Consensus Group on Microembolus Detection", Stroke, 29, pp.725~729 (1998)
- Spencer MP, "Detection of middle cerebral artery emboli during carotid endarterectomy using transcranial Doppler ultrasonography", Stroke, 21, pp.415~423 (1990)
- Adams HP Jr, "Embolism distal to stenosis of the middle cerebral artery", Stroke, 12, pp.228~229 (1981)
- Siebler M, "Cerebral microembolism and the risk of ischemia in asymptomatic high-grade internal carotid artery stenosis", Stroke, 26, pp.2184~2186 (1995)
- Segura T, "Embolism in acute middle cerebral artery stenosis", Neurology, 56, pp.497~501 (2001)
- Alexandrov AV, "Intracranial clot dissolution is associated with embolic signals on transcranial Doppler", J Neuroimaging, 10, pp.27~32 (2000)
- Droste DW, "Prevalence and frequency of microembolic signals in 105 patients with extracranial carotid artery occlusive disease", J Neurol Neurosurg Psychiatry, 67, pp.525~528 (1999)
- Boyajian RA, "Relationship of lumen diameter to type and degree of arterial remodeling at sites of expanding wall or plaque thickness in human carotid artery", Cerebrovasc Dis, 17, pp.228~237 (2004)
- Valton L, "Microembolic signals and risk of early recurrence in patients with stroke or transient ischemic attack", Stroke, 29, pp.2125~2128 (1998)
- Markus HS, "Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial", Circulation, 111, pp.2233~2240 (2005)
- Yamagami H, "Embolic cerebral infarction caused by intraluminal thrombus in the carotid siphon successfully treated with combination of anticoagulant and antiplatelet drugs", Circ J, 69, pp.1147~1149 (2005)