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Objective To explore the risk factors and investigate the intracranial vascular characteristics in elderly patients with WSI. Methods According to imaging features of DWI,56 cases of WSI were divided into CWSI,IWSI and MWSI group. Distribution of intracranial vascular le?sions in different groups was compared. The degree of middle cerebral artery(MCA)and internal carotid artery(ICA)stenosis in different types of WSI was investigated. Results Among 56 cases,85.7%of them had a history of hypertension,53.6%had diabetes,62.5%had hyperlipoidemia, 51.8%had coronary heart disease(CHD),51.8%had smoking,and 73.2%of them had two or more risk factors. Totally 11 cases(19.6%)of them were cortical watershed infarction(CWSI),13(23.2%)of them were interior watershed infarction(IWSI),and 32(57.1%)of them were mixed cerebral watershed infarction(MWSI). Among all the patients,the incidence of MCA stenosis(37.5%)and ICA stenosis(53.6%)were signifi?cantly higher than the other intracranial vessels(χ2=37.188,P<0.001). The incidence of MCA stenosis in IWSI group was significant higher than CWSI and MWSI group(χ2=12.00,P<0.01). The incidence of ICA stenosis in MWSI group was significantly higher than CWSI group and IWSI group(χ2=11.10,P<0.01). Among all the patients,17 of them had severe stenosis or occlusion in MCA(30.4%),and 22 of them had severe ste?nosis or occlusion in ICA(39.3%). The incidence of severe stenosis or occlusion in MCA(58.8%)was significant higher in IWSI group(χ2=7.588,P<0.05)and those in ICA was significantly higher in MWSI group(χ2=7.091,P<0.05). Conclusion MWSI is more common in elderly patients with WSI. Most of the patients have more than one risk factors such as hypertension,diabetes,hyperlipoidemia,CHD and smoking. MCA and ICA lesions are more common than other intracranial vessels in elderly patients. IWSI is closely related with severe stenosis and occlusion of MCA,while MWSI is closely related with severe stenosis and occlusion of ICA.
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Objective To explore the unique relationship between Willis circle and cerebral watershed infarction in a Chinese population. Methods A retrospective analysis of cerebral CT angiography was conducted in 471 non-cere?bral watershed infarctions and 93 MRI-diagnosed cerebral watershed infarctions (CWI)(including External CWI and In?ternal CWI)in Department of Neurology of our hospital and compare the related variations and types of Willis circle be?tween these groups. Results Compared with non-cerebral watershed infarctions, the prevalence of Uni-FTP (short for“fetal type of the Posterior cerebral artery”) in E-CWI (36.4%, P<0.05) and Bi-FTP in I-CWI (0%, P<0.05) was signifi?cantly higher in cerebral watershed infarctions. Conclusion FTP is probably an unique risk factor in Chinese patients with CWI.
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Objective To investigate the effect of progressive neurological deterioration ( PND) of cerebral watershed infarction on early prognosis. Methods The consecutive patients with cerebral watershed infarction admitted in the Department of Neurology,Jinling Hospital,Nanjing University School of Medicine and their cerebral watershed infarctions confirmed by the imaging examination from March 2009 to March 2014 were enrolled. The clinical features, laboratory indicators and imaging features of internal watershed infarction,cortical-type watershed infarction,and mixed watershed infarction were identified and analyzed. The National Institutes of Health Stroke Scale was used to score neurological deficit. The modified Rankin scale ( mRS) was used to score the prognosis of patients. Single factor analysis was used to compare the differences between the groups. At the same time,the correlation between PND and poor prognosis of cerebral watershed infarction at day 90 was analyzed by multivariable Logistic regression analysis. Results A total of 89 patients with cerebral watershed infarction were enrolled,including 43 cortical-type watershed infarctions,36 internal watershed infarctions, and 10 mixed watershed infarctions. Single factor analysis indicated that the incidences of PND of internal watershed infarction and mixed watershed infarction were significantly higher than the cortical-type watershed infarction (36. 1% [n=13],50. 0% [n=5], and 16. 3% [n=7],respectively;P=0. 018). At day 90,28 patients had poor prognosis,and mRS was (3.4±1. 0) scores at day 90. There was significant difference in the types of infarction between the patients with poor prognosis and patients with good prognosis (P<0. 05). In patients with poor prognosis, most of them were internal watershed infarctions,accounting for 50. 0% (14/28),while in patients with good prognosis,most of them were cortical-type watershed infarctions(57. 4% [35/61]). The incidence of PND in patients with poor prognosis was significantly higher than that in patients with good prognosis (57.1% [16/28] vs. 14. 8% [9/61];P<0. 05). The result of multivariate Logistic regression analysis showed that after adjustment for confounding factor, PND was independently associated with the poor prognosis of cerebral watershed infarction at day 90 (OR 6. 969,95%CI 2. 451-19. 869;P<0. 01). Conclusion Compared with the cortical-type watershed infarction, the patients with internal watershed infarction is more prone to have PND, and PND is independently correlate with the poor prognosis at day 90.
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Objective To evaluate the safety and efficacy of early carotid artery stenting in treating cerebral watershed infarction patients with carotid artery stenosis. Methods A total of 33 patients with acute cerebral watershed infarction complicated by carotid artery stenosis received carotid artery stenting within one week after the onset of the disease. The clinical safety and efficacy were evaluated. Results The carotid artery stenting was successfully accomplished in all 33 patients with a success rate of 100%. After the procedure, different degree of bradycardia and hypotension was seen in 23 patients, which restored to normal after prompt medication with atropine, dopamine, etc. During the procedure, one patients developed cerebral embolism due to dislodgment of emboli, resulting in contralateral hemiparalysis, and the contralateral limb muscle strength returned to preoperative status after proper treatment. After the treatment, no ipsilateral hemisphere excessive perfusion or cerebral hemorrhage occurred. Thirty days after the treatment, NHISS scores of the patients were obviously improved, which were significantly different from those determined before the treatment (P<0.05). Conclusion For the treatment of acute cerebral watershed infarction, early carotid artery stenting to relieve carotid artery stenosis is quite safe and it may improve the prognosis as well.
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Objective To investigate the pathogenesis of cerebral watershed infarction (CWI) through analyzing the appearance examined by Color duplex Imaging(CDI) and transcranial doppler (TCD).Methods One hundred and forty-two patients with CWI diagnosed by magnetic resonance imaging(MRI) were enrolled in the study group and 150 patients with acute cerebral infarction were enrolled in the control group.The results of CDI and TCD were retrospectively analyzed of the two groups.The vascular stenosis,plaque detection rate,plaque characteration,plaque scores,the cause of low blood volume,intracranial collateral circulation were compared between the two groups to investigate the pathogenesis of CWI.Results Among the 142 cases in the study group,there were 72 cases of severe stenosis and occlusion,21 cases of moderate stenosis,31 cases of mild stenosis and 18 cases without stenosis and there were 19 cases of severe stenosis and occlusion,41 cases of moderate stenosis,23 cases of mild stenosis and 67 cases without stenosis among the 150 cases in the control group.There were significant differences in the two groups (x2 =66.583,P =0.000).There were significant differences on the plaque detection rate between the two groups (80.99％ (115/142) vs 49.33％ (74/150),x2 =32.010,P =0.000).There were significant differences on the scores of plaque between the study group and the control group ((11.47 ± 3.78) points vs (6.57 ± 3.53) points,t =4.019,P =0.001).There were significant differences on the defined cause of low blood volume between the study group and the control group (54.93％ (78/142) vs 11.33％ (17/150),x2 =63.164,P =0.000).There were 50 patients had collateral circulation in the study group and 38 cases in the control group,there were no significant differences between the two groups (35.31％ (50/142) vs 25.33％ (38/150),x2 =3.381,P =0.066).Conclusion Angiostegnosis,microemboli from the unstable atherosclerosis plaque,lower perfusion on the basis of hypovolemia are all the pathogenesis of CWI.CDI combine with TCD can provide more information in vascular evaluation and treatment.
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Objective To investigate clinical features and the early recurrence factors of watershed infarction(WSI).Methods Two hundred and eighty-three patients with acute anterior circulation vascular infraction confirmed by CT or MRI were collected in Heilongjiang Province Hospital from January 2010 to December 2012.Patients' information including gender,sex,risk factors for stroke and vascular stenosis was colleced.Patients were divided into the lacunar infarction group (n =83),large infarction group(n =60) and the WSI group (n =140).All patients were followed up for 6 months to observe cerebral infarction recurrence status.The national institutes of health stroke scale(NIHSS) test of all patients was performed.Meanwhile the information including disease stage was collected and analysed.Results (1) The recurrent rate in WSI group,large infarction group and lacunar infarction group were 40.0％ (56/140),30.0％ (18/60),9.6％ (8/83)respectively.The difference between recurrent rate and lacunar infarction group was statistically significant(x2 =23.5,x2 =9.7,P ＜ 0.05),and the recurrent rate of WSI was highest.(2)The symptoms of patients with WSI were relatively mild in most patients after the initial stroke.75.7％ (106/140)WSI patients were 0-4 points regarding of NIHSS score,22.9％ (32/140) for 5-9 points and only 1.4％ (2/140) for more than 10 points.The clinical symptoms aggravated obviously in recurrent WSI patients.Of recurrent patients,28.6％ (16/56) were with high NIHSS score (score ≥ 10 points).(3)The difference between recurrent group and unrecurrent group in terms of unstable plaque,baseline systolic blood pressure,degree of stenosis ≥ 70％ was statistically significant(P ＜ 0.05).Conclusion The recurrent rate is higher in WSI group than other infarction type.The clinical symptoms are relatively mild in most of the WSI patients after the initial stroke,but the symptoms turn serious when stoke recurrent and the prognosis is poor.The unstable plaque,baseline systolic blood pressure,degree of stenosis ≥ 70％ may be the risk factors of stroke recurrence.
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Objective To study the clinical type and features of cerebral watershed infarction (CWI)in eldedy patients and its relationship with plasma lysophosphatidic acid(LPA).Method Analyzed the clinical data of 106 cases of CWI patients(CWI group)confirmed by cranial MRI,and compared plasma LPA levels in patients with different types of CWI,non-CWI patients(non-CWI group,36 cases)and healthy controls(control group,32 cases).Results In CWI group,anterior-cortex type 22 cases,LPA(4.93±0.72)μmol/L,posterior-cortex type 17 cases,LPA(4.75±0.81)μmoi/L,subcortical type 47 cases,LPA (5.46±1.03)μmol/L,mixed type 20 cages,LPA(6.02±1.12)μmol/L.In non-CWIgroup,LPA(5.37±1.24)μmol/L.In control group,LPA(2.92 ±0.36)μmol/L.The levels of LPA significandy increased in various types of CWI(P<0.05 or<0.01).of which mixed type and subcortical type were the highest,and the level of LPA in mixed type WaS higher than that in anterior-cortex type and posterior-cortex type(P<0.05).The level of LPA in non-CWI group was higher than that in control group,but there wss no significant difference compared with various types of CWI.Conclusions Subcortical type is the primal type in elderly CWI patients,the main cause of which is the atherosclerotic plaque formation and lumen stenosis.Platelet activation and its microemboli play an important role in the pathophysiology.LPA levels are significantly higher in various types of CWI,of which mixed type is the highest.LPA can be used as an important molecular marker to guide the sub-type treatment of CWI in elderly patients.