Relationship between Early Neurological Deterioration and Lenticulostriate Arteries Morphology in Patients with Single Subcortical Infarction

doi:10.3969/j.issn.1673-5765.2023.02.011

Abstract

Abstract: Objective To study the relationship between early neurological deterioration (END) and the morphology of lenticulostriate artery (LSA) in patients with single subcortical infarction (SSI) by using the whole brain magnetic resonance vessel wall imaging (MR VWI).
Methods The clinical data of patients with SSI without middle cerebral artery stenosis from Department of Neurology of Handan Central Hospital from October 2020 to January 2022 were retrospectively analyzed. Patients were divided into END group and non-END group according to occurring END or not. The visualization degree of LSA was evaluated by whole brain MR VWI. The LSA not seen in the basal ganglia was marked as poor visualization of LSA; the LSA covering less than half of the basal ganglia was marked as partial visualization of LSA; the LSA covering more than half of the basal ganglia was marked as good visualization of LSA. The correlation between END and visualization degree of LSA in patients with SSI was analyzed.
Results A total of 77 patients were included in this study, with an average age of 62.21±11.03 years and 51 males (56.7%). There were 16 patients (20.78%) in the END group and 61 patients (79.22%) in the non-END group. At the baseline, compared with the non-END group, the END group had a higher NIHSS score at admission (6.13±2.09 vs. 5.08±1.76, P=0.046), higher level of TC [(4.93±1.17) mmol/L vs. (4.34±0.76) mmol/L, P=0.018] and LDL-C [(2.92±0.69) mmol/L vs. (2.28±0.53) mmol/L, P=0.003] and a higher proportion of poor visualization of the LSA [8 (50.0%) vs. 11 (18.0%), P=0.026]. Multivariate logistic regression analysis showed that the high LDL-C level (OR 5.008, 95%CI 1.305-19.224, P=0.019) and poor visualization of LSA (OR 8.673, 95%CI 1.094-68.788, P=0.041) were independent risk factors for END.
Conclusion High LDL-C level and poor visualization of LSA were independent risk factors for END in patients with SSI and without middle cerebral artery stenosis.

Key words: Single subcortical infarction; Early neurological deterioration; Lenticulostriate artery; Magnetic resonance vessel-wall imaging

摘要： 目的利用全脑磁共振血管壁成像（magnetic resonance vessel wall imaging，MR VWI）研究单发皮层下梗死（single subcortical infarction，SSI）患者早期神经功能恶化（early neurological deterioration，END）与豆纹动脉（lenticulostriate artery，LSA）的关系。
方法回顾性分析邯郸市中心医院神经内二科2020年10月—2022年1月连续住院的不伴有脑大动脉狭窄的SSI患者，根据有无发生END分为END组和非END组，通过全脑MR VWI影像学方法评估LSA可视化程度，基底节区无法看到LSA记为LSA可视化差，LSA覆盖不到一半的基底节区域记为LSA部分可视化，LSA覆盖基底节区域一半以上的区域记为LSA可视化好。研究SSI患者发生END与LSA可视化程度之间的关系。
结果本次研究共纳入77例患者，其中END组16例（20.78%），非END组61例（79.22%）。患者平均（62.21±11.03）岁，男性51例（56.7%）。END组入院时NIHSS评分[（6.13±2.09）分 vs.（5.08±1.76）分，P=0.046]、TC[（4.93±1.17）mmol/L vs.（4.34±0.76）mmol/L，P=0.018]、LDL-C[（2.92±0.69）mmol/L
vs.（2.28±0.53）mmol/L，P=0.003]和LSA可视化差（50.0% vs. 18.0%，P=0.026）均高于非END组。多因素logistic回归分析显示，高LDL-C水平 (OR 5.008，95%CI 1.305～19.224，P=0.019）和LSA可视化差（OR 8.673，95%CI 1.094～68.788，P=0.041）是患者发生END的独立危险因素。
结论高LDL-C水平和LSA可视化差是SSI且无脑大动脉狭窄患者发生END的独立危险因素。

关键词: 单发皮层下梗死; 早期神经功能恶化; 豆纹动脉; 磁共振血管壁成像

LIU Tiantian, HUO Huiyong, XIANG Shifeng, LIU Chao, ZHANG Wenchao, LI Juntao.

Relationship between Early Neurological Deterioration and Lenticulostriate Arteries Morphology in Patients with Single Subcortical Infarction

[J]. Chinese Journal of Stroke, 2023, 18(02): 208-212.

刘甜甜, 霍会永, 相世峰, 刘超, 张文超, 李军涛. 单发皮层下梗死患者早期神经功能恶化与豆纹动脉关系的研究[J]. 中国卒中杂志, 2023, 18(02): 208-212.

References

[1] FISHER C M. The vascular lesion in lacunae[J]. Trans Am Neurol Assoc，1965，90：243-245.
[2] CAPLAN L R. Intracranial branch atheromatous disease：a neglected，understudied，and underused concept[J]. Neurology，1989，39（9）：1246-1250.
[3] YAMAMOTO Y，NAGAKANE Y，TOMII Y，et al. The relationship between progressive motor deficits and lesion location in patients with single infarction in the lenticulostriate artery territory[J]. J Neurol，2017，264（7）：1381-1387.
[4] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南 2018[J]. 中华神经科杂志，2018，51（9）：666-683.
[5] JIANG S，CAO T，YAN Y Y，et al. Lenticulostriate artery combined with neuroimaging markers of cerebral small vessel disease differentiate the pathogenesis of recent subcortical infarction[J]. J Cereb Blood Flow Metab，2021，41（8）：2105-2115.
[6] XIE W W，WANG C，LIU S，et al. Visualization of lenticulostriate artery by intracranial dark-blood vessel wall imaging and its relationships with lacunar infarction in basal ganglia：a retrospective study[J]. Eur Radiol，2021，31（8）：5629-5639.
[7] 门雪娇，陈玮琪，许玉园，等. 穿支动脉粥样硬化病中国专家共识[J]. 中国卒中杂志，2021，16（5）：508-514.
[8] DEGUCHI I，HAYASHI T，KATO Y，et al. Treatment outcomes of tissue plasminogen activator infusion for branch atheromatous disease[J/OL]. J Stroke Cerebrovasc Dis，2013，22（7）：e168-e172[2022-09-10]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.10.012.
[9] KIM D E，CHOI M J，KIM J T，et al. Two different clinical entities of small vessel occlusion in toast classification[J]. Clin Neurol Neurosurg，2013，115（9）：1686-1692.
[10] ZHANG Z，FAN Z Y，KONG Q L，et al. Visualization of the lenticulostriate arteries at 3T using black-blood T1-weighted intracranial vessel wall imaging：comparison with 7T TOF-MRA[J]. Eur Radiol，2019，29（3）：1452-1459.
[11] JIANG S，YAN Y Y，YANG T，et al. Plaque distribution correlates with morphology of lenticulostriate arteries in single subcortical infarctions[J]. Stroke，2020，51（9）：2801-2809.
[12] SUZUKI T，NATORI T，SASAKI M，et al. Evaluating recanalization of relevant lenticulostriate arteries in acute ischemic stroke using high-resolution MRA at 7T[J]. Int J Stroke，2021，16（9）：1039-1046.
[13] GROCHOWSKI C，KRUKOW P，JONAK K，et al. The assessment of lenticulostriate arteries originating from middle cerebral artery using ultra high-field magnetic resonance time-of-flight angiography[J]. J Clin Neurosci，2019，68：262-265.
[14] TANAKA K，MATSUMOTO S，FURUTA K，et al. Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator[J]. J Thromb Thrombolysis，2020，49（4）：545-550.
[15] FEEKES J A，HSU S W，CHALOUPKA J C，et al. Tertiary microvascular territories define lacunar infarcts in the basal ganglia[J]. Ann Neurol，2005，58（1）：18-30.
[16] PHAN T G，VAN DER VOORT S，BEARE R，et al. Dimensions of subcortical infarcts associated with first- to third-order branches of the basal ganglia arteries[J]. Cerebrovasc Dis，2013，35（3）：262-267.
[17] CHEN W，YI T Y，ZHAN A L，et al. Clinical significance of common-stem lenticulostriate arteries in patients with internal watershed infarction[J]. Neurol Sci，2019，40（11）：2303-2309.
[18] YAMADA M，YOSHIMURA S，KAKU Y，et al. Prediction of neurologic deterioration in patients with lacunar infarction in the territory of the lenticulostriate artery using perfusion CT[J]. AJNR Am J Neuroradiol，2004，25（3）：402-408.
[19] SUN S，WANG Y，WANG Y，et al. Lipid and hyperglycemia factors in first-ever penetrating artery infarction，a comparison between different subtypes[J/OL]. Brain Behav，2017，7（6）：e00694.[2022-09-10].https://doi.org/10.1002/brb3.694.