ICAS所致急性缺血性卒中的斑块特征与发病机制关系研究

doi:10.3969/j.issn.1673-5765.2025.09.005

摘要/Abstract

摘要： 目的应用高分辨率磁共振血管壁成像（high resolution magnetic resonance vessel wall imaging，HR-MRI VWI）技术，研究颅内动脉粥样硬化性狭窄（intracranial atherosclerotic stenosis，ICAS）所致急性缺血性卒中患者的颅内动脉血管壁斑块特征，并探讨斑块特征与不同发病机制之间的相关性。
方法回顾性分析2017年1月—2023年4月北京清华长庚医院神经内科收治的ICAS所致急性缺血性卒中患者。ICAS所致急性缺血性卒中的发病机制可分为以下4类：①载体动脉粥样硬化阻塞穿支机制；②动脉到动脉栓塞机制；③低灌注机制；④混合机制。收集患者的临床资料，并使用HR-MRI VWI技术获取颅内动脉血管壁斑块特征（包括最大管壁厚度、狭窄率、斑块负荷、重构指数、斑块内出血及斑块表面不规则）。比较ICAS所致急性缺血性卒中患者不同发病机制之间的颅内动脉血管壁斑块特征差异，并采用多因素logistic回归分析探究斑块特征与不同发病机制的相关性。
结果本研究共纳入204例患者，平均年龄为（67.5±11.0）岁，男性130例（63.73%）。不同发病机制之间颅内动脉血管壁斑块特征的差异具有统计学意义。多因素logistic回归分析显示，斑块表面不规则与载体动脉粥样硬化阻塞穿支机制相关；最大管壁厚度、斑块内出血、斑块表面不规则及重构指数与动脉到动脉栓塞机制相关；最大管壁厚度、斑块内出血、斑块表面不规则及重构指数与低灌注机制相关；斑块表面不规则及重构指数与混合机制相关。
结论不同发病机制的ICAS所致急性缺血性卒中患者具有相对特异的颅内动脉血管壁斑块特征。HR-MRI VWI技术有助于临床区分ICAS所致急性缺血性卒中的不同发病机制。

文章导读： 应用高分辨率磁共振血管壁成像技术，可精准评估不同发病机制的ICAS所致急性缺血性卒中患者的颅内动脉血管壁斑块特征，区分不同发病机制的影响因素。

关键词: 缺血性卒中; 高分辨率磁共振血管壁成像; 动脉粥样硬化; 发病机制

Abstract: Objective To investigate the characteristics of intracranial arterial wall plaques in patients with acute ischemic stroke caused by intracranial atherosclerotic stenosis (ICAS) using high resolution magnetic resonance vessel wall imaging (HR-MRI VWI) technique, and to explore the correlation between plaque characteristics and the different pathogenetic mechanisms.
Methods A retrospective analysis was made on patients with acute ischemic stroke caused by ICAS, who were admitted to the Department of Neurology, Beijing Tsinghua Changgung Hospital from January 2017 to April 2023. The pathogenetic mechanisms of acute ischemic stroke caused by ICAS was divided into the following four categories: parent artery atherosclerosis occluding perforator arteries mechanism, artery-to-artery embolism mechanism, hypoperfusion mechanism, and mixed mechanism. The clinical data of patients were collected, and HR-MRI VWI was used to obtain the characteristics of intracranial arterial wall plaques, including maximum wall thickness, stenosis rate, plaque burden, remodeling index, intraplaque hemorrhage, and irregular plaque surface. Differences in intracranial arterial wall plaque characteristics among patients with different pathogenetic mechanisms of acute ischemic stroke caused by ICAS were compared. Multivariate logistic regression analysis was used to investigate the correlation between plaque characteristics and different pathogenetic mechanisms.
Results A total of 204 patients were enrolled in this study with a mean age of (67.5±11.0) years, including 130 males (63.73%). There were statistically significant differences in the characteristics of intracranial arterial wall plaques among patients with acute ischemic stroke caused by ICAS with different pathogenetic mechanisms. Multivariate logistic regression analysis showed that irregular plaque surface was associated with the parent artery atherosclerosis occluding perforator arteries mechanism. The maximum wall thickness, intraplaque hemorrhag, irregular plaque surface, and remodeling index were associated with the artery-to-artery embolism mechanism. The maximum wall thickness, intraplaque hemorrhag, irregular plaque surface, and remodeling index were associated with the hypoperfusion mechanism. Irregular plaque surface and remodeling index were associated with the mixed mechanism.
Conclusions Patients with acute ischemic stroke caused by ICAS with different pathogenetic mechanisms have relatively specific characteristics of intracranial arterial wall plaque. HR-MRI VWI technique is helpful for clinically distinguishing different pathogenetic mechanisms of acute ischemic stroke caused by ICAS.

Key words: Ischemic stroke; High resolution magnetic resonance vessel wall imaging; Atherosclerosis; Pathogenetic mechanism

中图分类号:

解正绮, 宋晓微. ICAS所致急性缺血性卒中的斑块特征与发病机制关系研究[J]. 中国卒中杂志, 2025, 20(9): 1104-1112.

XIE Zhengqi, SONG Xiaowei. Study on the Relationship between Plaque Characteristics and Pathogenesis of Acute Ischemic Stroke Caused by ICAS[J]. Chinese Journal of Stroke, 2025, 20(9): 1104-1112.

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