The Characteristics Of Cerebral Watershed Infarction And Related Factors Of Early Recurrence

Objective To investigate clinical features and the discrepancy of infarct patterns bydifferent responsible blood vessels and research early recurrence of CWI and its relatedfactors.Methods The data of132patients of acute CWI confirmed by magnetic resonancediffusion weighted imaging (MR-DWI) were collected in our hospital and to research thecliniacal features. Thoses patients were grouped into the ICA group and the MCA groupaccording to responsibility of blood vessels and then to analyze and compare thediscrepancy of its infarction types.121patients were followed up for1month to observecerebral infarction recurrence and to find out its related factors.Result1. The infarction types of internal infarction watershed (ICWI) and posteriorwatershed infarction were most common in CWI and the rate was87.88%and57.85%respectively. Compared to the ICA group,the types of the anterior CWI and anterior CWI+ICWI+posterior CWI were more common in the ICA group,there was significantlystatistic discrepancy between two groups (p=0.003and0.027). But the type of cortexupper and merged lesion were more common in the MCA group, there was significantlystatistic discrepancy(p=0.042and0.036).2. The symptoms were relatively mild in most patients after the initial stroke,theNIHSS score0～4points accounted for77.34%,5～7points19.54%and≥10points only3.125%.3.121patiens were followed up for1month,36patients recurred and1patient wasdead,The proportion of recurrence was13.22%,20.66%,29.75%within1week,2weeksand1month respectively. The clinical symptoms aggratated obviously in these patients andthe rate of NIHSS score≥10points patients was26.92%,the prognosis is very poor.4.The analysis of related factors of stroke early recurrence showed that unstableplaque,baseline systolic blood pressure,degree of stenosis≥90%,active antihypertensivetreatment and CIR were significantly positively correlative (p=0.032、0.009、0.019and 0.038respectively). The treatment of expansion blood volume, stent treatment and CIRwere significantly negatively correlative (p=0.047and0.044). Logistic regression diplayedthat the unstable plaque (OR4.929，95%CI1.491-16.296，p=0.009), baseline systolic bloodpressure≤140mmHg (OR2.573，95%CI0.928-7.131，p=0.069), the degree of stenosis≥90%(OR6.072，95%CI2.115-17.430，p=0.001) and antihypertensive therapy (OR3.840，95%CI1.418-10.400，p=0.008) were independent risk factors of CIR. The treatment ofexpansion blood volume（OR0.255，95%CI0.063～1.024，p=0.054） and stent treatment（OR=0.046，95%CI0.005-0.402，p=0.005）did a favorable factor to prevent CIR.5．Regional infarct and CWI were the main infarction types after recurrence,accounting for46.15%and26.92%respectively.conclusion1.The ICWI and posterior CWI are most common patterns of CWI. Anterior CWI andanterior CWI+ICWI+posterior CWI are more common in ICA lesions and that meanshemodynamic compromise may play a important role. The MCA lesion are prone to cortexupper and merged lesion and its mechanisms are more prone to embolism on thefoundation of hemodynamic compromise.2. The clinical symptoms are relatively mild in most of the CWI patients after theinitial strok, but it is easy to recure in1month.After recurrence, the symptoms turn seriousand there is a high rate of morbidity and a poor prognosis.3. The stable plaque, baseline systolic blood pressure, degree of stenosis≥90%andactive antihypertensive treatment are independent risk factors of CIR. The treatment ofexpansion blood volume and stent treatment do a favorable factor to prevent CIR.4．Many clinicians are still lack of knowledge and assessment about the high rate ofrecurrence and morbidity of CWI.We should make clear to responsible blood vessel andthe site of CWI as soon as possible and give their individualized treatment respectivelyaccording to the etiology and mechanism.