| Objectives To analyze the clinical data and high-resolution magnetic resonance imaging features of patients with acute isolated infarction in the middle cerebral artery,to investigate the relationship between the characteristics and location of carrier artery plaques and cerebral infarction,and to explore the pathogenesis of infarction in the penetrating arteries,so as to provide a basis for clinical diagnosis and treatment.Methods General information such as age,gender,history of hypertension,history of diabetes,history of smoking,history of alcohol consumption,national institude of health stroke scale score(NIHSS)on the day of admission,and laboratory findings including lipid index,homocysteine,platelet count,and degree of stenosis was collected from patients with acute isolated cerebral infarction with an atherosclerotic plaque in the M1 segment of the middle cerebral artery ipsilateral to the cerebral infarction between October 2017 and October 2020.High-resolution magnetic resonance techniques were used to observe and record the number of plaques,assess their nature and their quadrants.Based on the infarct site on diffusion weighted imaging,the penetrating artery group was divided into a penetrating artery group and a non-penetrating artery group,and the penetrating artery group was further divided into a carrier artery superior wall group and a carrier artery non-superior wall group according to the location of the plaque on high resolution magnetic resonance imaging T1-weighted imaging images.The relationship between cerebral infarction and atherosclerotic plaque characteristics and location was analyzed and the relevant data were statistically analyzed using SPSS statistical software;P<0.05 was considered to be statistically different.Results 1 Fifty-three patients with acute isolated cerebral infarction in the middle cerebral artery region according to the inclusion criteria are included in the analysis.Of these,28 patients(52.83%)are in the penetrating artery group and 25 patients(47.17%)are in the non-penetrating artery group.The mean age of the penetrating artery group is 61.00(51.50,65.50)years older than that of the non-penetrating artery group 50.00(41.00,59.50)years,and the mean platelet count is 227.00(211.00,249.50)×10~9/L higher in the penetrating artery group than in the non-penetrating artery group 205.00(187.00,243.00)×10~9/L.The percentage of vulnerable plaque was lower in the penetrating artery group(51.72%)than in the non-penetrating artery group(88.89%),with statistically significant differences in both groups(P<0.05).Correlation analysis shows a weak negative correlation between infarct site and age(r=-0.395,P=0.003)in the penetrating artery group or non-penetrating artery group,suggesting that patients in the penetrating artery group were older;a moderate positive correlation with plaque nature(r=0.404,P=0.006),suggesting that patients in the non-penetrating artery group had more vulnerable plaque;and no significant correlation with platelet count(P=0.103).2 Of the 28 patients with plaque in the penetrating artery group:10(35.71%)in the carrier artery superior group and 18(64.29%)in the carrier artery non-superior group.The mean NIHSS score was higher in the carrier arterial superior group(3.50±0.97)than in the carrier arterial non-superior group(1.67±1.02).The average diameter of infarct lesion in the superior wall of carrier artery group was(24.60±2.22)mm larger than that in the non-superior wall of carrier artery group(13.89±4.57)mm.The mean total cholesterol was 4.66(4.23,5.03)mmol/L in the carrier artery superior group compared with 3.80(3.10,4.67)mmol/L in the carrier artery non-superior group,and the mean LDL was(3.08±0.54)mmol/L in the carrier artery superior group compared with(2.39±0.75)mmol/L in the carrier artery non-superior group,with statistically significant differences between the above two groups(P<0.05).Correlation analysis showed a significant negative correlation between plaque location and NIHSS score(r=-0.670,P<0.001);a significant negative correlation with infarct focus diameter(r=-0.791,P<0.001);a significant negative correlation with low-density lipoprotein cholesterol(r=-0.443,P=0.018);and no significant correlation with total cholesterol(P=0.103).In a partial correlation analysis after removing the effect of confounding factors,plaque location had a moderate negative correlation with NIHSS score(r=-0.481,P=0.015),suggesting a higher NIHSS score in the carrier artery superior wall plaque group,and a strong negative correlation with infarct diameter(r=-0.727,P<0.001),suggesting a larger infarct diameter in the carrier artery superior wall plaque group There was no significant correlation between plaque location and low-density lipoprotein cholesterol(P=0.230).Conclusions 1 The higher susceptibility of plaques in the M1 segment of the middle cerebral artery in patients with acute isolated cerebral infarction in non-penetrating arteries suggests that the mechanism of infarction may be artery-artery embolism associated with the vulnerable plaque.2 Patients with superior plaque in the M1 segment of the middle cerebral artery have larger infarct diameters and higher NIHSS scores,suggesting that the plaque may be blocking the opening of the penetrating artery,while the infarction in patients with non-superior plaque may be related to arterial-arterial embolism or disease of the penetrating artery itself.Figure 1;Table 6;Reference 154... |
PDF Full Text Request