摘要
目的：急性孤立性桥脑脑梗死（AIPI）的早期临床恶化（ECW）很常见，与预后不良有关，其预测因素尚未充分明确。本文研究了双侧基底动脉（BA）解剖在 AIPI 患者 ECW 中可能起的作用：方法：在 146 名 AIPI 患者中，将梗塞分为水平方向上的被盖区、外侧、前外侧和前内侧；垂直方向上的低位、中位、中上位和上部桥脑。根据 Smoker 标准，对 BA 多发性神经节畸形进行分类。此外，还描述了 BA 侧位角的附加标准。测量梗死长轴与 BA 横截面中心之间的长度，并命名为 "分支长度（BL）"。ECW 的定义是 NIHSS 的任何增加：22例（15%）患者出现ECW。单变量分析显示，这些患者中女性比例更高（22% vs. 10%，P=0.007），心房颤动更高（18% vs. 7%，P=0.067），前内侧梗死位置更常见（77% vs. 49%，P=0.025），吸烟者 BA 高度为 3 类（32% vs. 10%，P=0.043）。在前内侧脑梗死中，BL较长（8.3 vs. 6.1 mm，P=0.052），在位于中上/上桥脑水平的脑梗死中，BL达到显著水平（1.22 vs. 0.62 mm，P=0.006）。BL>4.4毫米显示了对ECW可接受的鉴别能力，其ROC的AUC为0.615（95% CI：0.511-0.712）。回归模型显示女性性别（β±SE=1.129±0.551，P=0.040）、BL（每 4.4 mm，β±SE=1.236±0.614，P=0.044）和 BA 高度-3 类（β±SE=1.711±0.645，P=0.008）是 ECW 的独立预测因素：结论：基底动脉粥样硬化的一些特征，如BA顶端高度的极端位置和受累穿孔在桥脑前囊的长度，可能是急性孤立性桥脑梗死早期临床恶化的预测因素。Objectives: Early clinical worsening (ECW) in acute isolated pontine infarcts (AIPI) is frequent, associated with poor prognosis, and its predictors have not been adequately clarified. A possible role of dolichoectatic basilar artery (BA) anatomy in ECW in patients with AIPI is herein studied.
Methods: In 146 AIPI patients, infarcts were grouped into tegmental, lateral, anterolateral, anteromedial horizontally; and low, mid, mid-up, and upper pontine vertically. BA dolichoectasia was categorized according to Smoker criteria. An additional criteria of BA laterality angle was described. The length between the infarct long-axis and BA cross-sectional center was measured, and named as "branch length (BL)." ECW was defined as any increase in NIHSS.
Results: ECW was seen in 22 (15%) patients. Univariate analysis documented a higher female ratio (22% vs. 10%, P=0.007), higher atrial fibrillation (18% vs. 7%, P=0.067), more common anteromedial infarct location (77% vs. 49%, P=0.025), and Smoker category-3 BA height (32% vs. 10%, P=0.043) in these patients. In anteromedial infarcts, BL was longer (8.3 vs. 6.1 mm, P=0.052), and reaching to significance in those located at mid-up/upper pontine level (1.22 vs. 0.62 mm, P=0.006). BL >4.4 mm showed an acceptable discriminatory capacity for ECW with an AUC of ROC: 0.615 (95% CI: 0.511-0.712). A regression model indicated female sex (β±SE=1.129±0.551, P=0.040), BL (per 4.4 mm, β±SE=1.236±0.614, P=0.044), and BA height-category-3 (β±SE=1.711±0.645, P=0.008) as independent predictors for ECW.
Conclusions: Some features of basilar dolichoarteriopathy, such as the extreme location of the height of the BA tip and the length of the involved perforator in the prepontine cistern, may be predictors of early clinical worsening in acute isolated pontine infarcts.
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