HR-MRI血管壁成像在不同年龄大脑中动脉急性闭塞患者机械取栓术后的诊疗价值研究

doi:10.3969/j.issn.1673-5765.2021.11.011

摘要/Abstract

摘要： 目的比较青年和中老年大脑中动脉急性闭塞患者动脉机械取栓血管再通后HR-MRI血管壁成像的特点。方法回顾性纳入2015年6月-2018年6月在深圳市宝安人民医院神经外科确诊并行大脑中动脉急性闭塞机械取栓治疗患者的资料。根据患者入院时年龄分为青年组（≤45岁）和中老年组（＞45岁），比较两组机械取栓血管再通术后4周和6个月患侧大脑中动脉的HR-MRI血管壁成像特点（管腔狭窄率、管壁重构指数、动脉粥样硬化斑块厚度及斑块强化率）及1年预后情况（mRS≤3分为预后良好）。结果共纳入30例患者，其中青年组16例，中老年组14例。机械取栓血管再通术后4周，两组责任侧大脑中动脉管腔狭窄率、重构指数、动脉粥样硬化斑块厚度及斑块强化率比较差异无统计学意义。机械取栓血管再通术后6个月，青年组治疗侧大脑中动脉管腔狭窄率（37.47%±0.04% vs 60.00%±0.11%，P =0.024）、动脉粥样硬化斑块厚度（0.63±0.18 mm vs 1.56±0.35 mm，P =0.016）及斑块强化率（0.35%±0.17% vs 0.57%±0.24%，P =0.043）低于中老年组。两组间术后6个月时管壁重构指数和1年良好预后率差异均无统计学意义。结论与青年相比，中老年患者患侧大脑中动脉机械取栓再通术后的管腔狭窄程度、动脉粥样硬化斑块厚度及斑块强化率更高，提示年龄可能是脑血管动脉粥样硬化斑块进展的影响因素。

文章导读： 大脑中动脉急性闭塞再通后，中老年患者更易出现血管再闭塞。HR-MRI血管壁成像可筛查出高危患者并及时行补救性介入治疗，降低血管的再闭塞率。

关键词: 大脑中动脉急性闭塞; 高分辨磁共振血管壁成像; 动脉粥样硬化; 机械取栓; 预后

Abstract: Objective To compare the characteristics of HR MR vessel wall imaging (HR-MRVWI) of culprit artery in young patients and middle-aged and elderly patients with acute middle cerebral artery (MCA) occlusion after recanalization. Methods This retrospective study enrolled the patients with acute MCA occlusion who underwent mechanical recanalization in Department of Neurosurgery of Shenzhen Bao'an People's Hospital from June 2015 to June 2018. The clinical data such as general information, laboratory examination, NIHSS score, HR-MRVWI, mRS score were collected. Taking 45 years as the age limit, the patients were divided into young group (≤45 years) and middle-aged and elderly group (>45 years). The degree of stenosis, vessel wall remodeling index, plaque thickness and enhancement rate of the culprit MCA at 4 weeks and 6 months after recanalization and 1-year prognosis between the two groups were compared. Good prognosis was defined as a mRS score of 0 to 3. Results A total of 30 patients were included, with 16 cases in young group and 14 cases in middle-aged and elderly group. There were no statistical differences in stenosis rate, remodeling

index, plaque thickness and enhancement rate of MCA between the two groups at 4 weeks after

recanalization. The degree of MCA stenosis [(37.47±0.04)% vs (60.00±0.26)%, P =0.024], plaque thickness (0.63±0.18 mm vs 1.56±0.35 mm, P =0.016) and enhancement rate [(0.35±0.17)% vs (0.57±0.24)%, P =0.043] of the young group were significantly lower than those of the middleaged and elderly group at 6 months. There were no statistical differences in the remodeling rate at 6 months and mRS scores at 1 year between the two groups. Conclusions Compared to the young patients, the degree of stenosis, plaque thickness and enhancement rate of culprit MCA were higher in the middle-aged and elderly patients, suggesting that age may be an important contributing factor for plaque progression.

Key words: Acute middle cerebral artery occlusion; High-resolution magnetic resonance vessel
wall imaging; Atherosclerosis; Mechanical thrombectomy; Prognosis

胡建刚, 廖文楷, 郑勇, 宋建勋, 叶华卫, 黄居科. HR-MRI血管壁成像在不同年龄大脑中动脉急性闭塞患者机械取栓术后的诊疗价值研究[J]. 中国卒中杂志, 2021, 16(11): 1150-1155.

HU Jian-Gang, LIAO Wen-Kai, ZHENG Yong, SONG Jian-Xun, YE Hua-Wei, HUANG Ju-Ke. Characteristics of HR MR Vessel Wall Imaging of Culprit Artery after Recanalization in Yong and Elder Patients with Acute Middle Cerebral Artery Occlusion[J]. Chinese Journal of Stroke, 2021, 16(11): 1150-1155.

参考文献

[1] GAO F，LO W T，SUN X，et al. Combined use of
mechanical thrombectomy with angioplasty and
stenting for acute basilar occlusions with underlying
severe intracranial vertebrobasilar stenosis：
preliminary experience from a single Chinese
center[J]. AJNR Am J Neuroradiol，2015，36（10）：
1947-1952.
[2] HORIE N，TATEISHI Y，MORIKAWA M，et
al. Acute stroke with major intracranial vessel
occlusion：characteristics of cardioembolism and
atherosclerosis-related in situ stenosis/occlusion[J/
OL]. J Clin Neurosci，2016，32：24-29[2021-02-02].
https：//doi.org/10.1016/j.jocn.2015.12.043.
[3] JIA B X，FENG L，LIEBESKIND D S，et al.
Mechanical thrombectomy and rescue therapy for
intracranial large artery occlusion with underlying
atherosclerosis[J]. J Neurointerv Surg，2018，10（8）：
746-750.
[4] GOYAL M，DEMCHUK A M，MENON B K，et
al. Randomized assessment of rapid endovascular
treatment of ischemic stroke[J]. N Engl J Med，2015，
372（11）：1019-1030.
[5] 王艳，陈志恒，王瑜，等. 脑血流动力学指标变化与
脑血管老化关系[J]. 中国公共卫生，2017，33（8）：
1182-1186.
[6] LIANG J Y，GUO J，LIU D X，et al. Application of
high-resolution CUBE sequence in exploring stroke
mechanisms of atherosclerotic stenosis of middle
cerebral artery[J]. J Stroke Cerebrovasc Dis，2019，
28（1）：156-162.
[7] VANDER KOLK A G，ZWANENBURG J J，
DENSWIL N P，et al. Imaging the intracranial
atherosclerotic vessel wall using 7T MRI：initial
comparison with histopathology[J]. AJNR Am J
Neuroradiol，2015，36（4）：694-701.
[8] LEE S J，LEE D G. Distribution of atherosclerotic
stenosis determining early neurologic deterioration
in acute ischemic stroke[J/OL]. PLoS One，2017，12
（9）：e0185314[2021-02-02]. https：//doi.org/10.1371/
journal.pone.0185314.
[9] MANDELL D M，MATOUK C C，FARB R I，et al.
Vessel wall MRI to differentiate between reversible
cerebral vasoconstriction syndrome and central
nervous system vasculitis：preliminary results[J].

Stroke，2012，43（3）：860-862.

[10] SIEGLER J E，BOEHME A K，KUMAR A D，et
al. Identification of modifiable and nonmodifiable
risk factors for neurologic deterioration after acute
ischemic stroke[J/OL]. J Stroke Cerebrovasc Dis，
2013，22（7）：e207-e213[2021-02-02]. https：//doi.
org/10.1016/j.jstrokecerebrovasdis.2012.11.006.
[11] VON INGERSLEBEN G，SCHMIEDL U P，
HATSUKAMI T S，et al. Characterization of
atherosclerotic plaques at the carotid bifurcation：
correlation of high-resolution MR imaging
with histologic analysis-preliminary study[J].
Radiographics，1997，17（6）：1417-1423.
[12] EPSTEIN K A，VISCOLI C M，SPENCE J D，et
al. Smoking cessation and outcome aftern ischemic
stroke or TIA[J]. Neurology，2017，89（16）：1723-
1729.
[13] MA N，JIANG W J，LOU X et al. Arterial
remodeling of advanced basilar atherosclerosis：a
3-tesla MRI study[J]. Neurology，2010，75（3）：253-
258.

[1]	王恺闻, 卢宝全, 吴秀玲, 马佳丽. 基于MRA评估基底动脉闭塞预后评分预测非重症基底动脉闭塞患者预后效能的研究 [J]. 中国卒中杂志, 2022, 17(12): 1335-1342.
[2]	吴晓莉, 刘丽旭. 肥胖对卒中预后的影响[J]. 中国卒中杂志, 2022, 17(12): 1391-1395.
[3]	伊珞, 周宏宇, 仇鑫, 李子孝, 王拥军. 动脉粥样硬化性疾病的DNA甲基化改变[J]. 中国卒中杂志, 2022, 17(11): 1163-1170.
[4]	邓宇含, 刘爽, 王子尧, 汪雨欣, 刘宝花. 基于结构化数据和机器学习模型预测普通人群卒中发病风险的系统评价和meta分析 [J]. 中国卒中杂志, 2022, 17(11): 1189-1197.
[5]	付江红, 陈树耿, 束小康, 蒋泽武, 魏栋帅, 贾杰. 脑机接口训练对卒中后感觉障碍患者运动功能恢复的影响：1项探索性研究[J]. 中国卒中杂志, 2022, 17(10): 1051-1057.
[6]	赵永瑞, 刘展会. 弥散张量成像在缺血性卒中患者运动功能预后评估中的研究进展[J]. 中国卒中杂志, 2022, 17(10): 1114-1119.
[7]	徐蔚海, 李顺, 程安琪. 青年卒中的诊治：勿过激[J]. 中国卒中杂志, 2022, 17(09): 915-918.
[8]	刘伊桐, 黄燕琪, 李明利, 冯逢, 高山, 徐蔚海. 颈动脉几何形态——60岁及以下无高危因素人群颅内动脉粥样硬化的潜在预测指标[J]. 中国卒中杂志, 2022, 17(09): 925-931.
[9]	吕微, 王安心, 田雪, 张晓丽, 许玉园, 孟霞. 心血宁胶囊对伴高同型半胱氨酸水平缺血性卒中患者短期功能预后的影响[J]. 中国卒中杂志, 2022, 17(09): 972-976.
[10]	豆朋宇, 班梦苛, 贵永堃, 包万利, 张平. 脑白质高信号与孤立大脑中动脉重度狭窄或闭塞患者临床预后的相关性研究[J]. 中国卒中杂志, 2022, 17(09): 985-990.
[11]	龚宇田, 黎洁洁. IL-6和动脉粥样硬化性缺血性卒中的关系研究进展[J]. 中国卒中杂志, 2022, 17(09): 1022-1026.
[12]	雷延成, 刘著, 王进鹏, 张豪, 杨文芳, 肖顺熙, 杨慧洁, 莫海珍, 陈燕. 高海拔地区缺血性卒中患者单核细胞/HDL-C比值与脑动脉粥样硬化性狭窄的相关性 [J]. 中国卒中杂志, 2022, 17(08): 829-833.
[13]	吴倩, 陶立元, 陈思琪, 钟莲梅, 刘丽萍, 米东华. 血糖波动对动脉瘤性蛛网膜下腔出血后迟发性脑缺血及30天死亡的影响 [J]. 中国卒中杂志, 2022, 17(08): 845-850.
[14]	宋绪林, 陈来照, 韦明桂. 大脑前动脉A2段构型对左侧翼点入路夹闭前交通动脉瘤的影响 [J]. 中国卒中杂志, 2022, 17(08): 851-856.
[15]	中国卒中学会神经介入分会. 症状性颅内动脉粥样硬化性狭窄血管内治疗中国专家共识2022[J]. 中国卒中杂志, 2022, 17(08): 863-888.