The Study Of The Relationship Between Cerebral Watershed Infraction And Ipsilateral Vessel Stenosis And The Nature Of Carotid Plagues

Objectives To investigate the relative facters of cerebral watershed infractions and therelationships among different types of CWI on the nature of lesion side carotid plagues,the lesion side responsible blood vessels and the degree of stenosis, in order to providethe basis theory for the individuation treatment and secondary prevention.Methods The date of403patients of acute cerebral infarction confirmed by magneticresonance diffusion weighted imaging were collected in our hospital. According to theimaging characteristic, all the patients were divided into two groups: the CWI and non-CWI. And analysis the clinical characteristic of CWI. CWI patients were devidied intothree subgroups according to Bogousslavsky classification and compare their differentson the nature of lesion side carotid plagues, the lesion side responsible blood vessels andthe degree of stenosis.Results1Between two groups(CWI, non-CWI), there were no statistically significantdifferences about the discrepancy in sex, age, smoking, drinking, stroke, hypertension,diabetes, coronary heart disease, dyslipidemia, WBC, RBC, HGB, PLT, FIB, UA, GLUand the nature of lesion side carotid plagues, the degree of the lesion side ACA, PCAstenosis(P>0.05). There were statistically significant differences about the systolic bloodpressure, diastolic blood pressure, mean arterial pressure, NIHSS score when they wereadmitted to hospital and the detection rate of carotid plagues, the degree of the lesion sideICA, MCA stenosis, lesion vessel numbers of the lesion side(P<0.05).2Logisticregression displayed that the mean arterial pressure(OR=0.976,95%CI0.958~0.994,P=0.010)when they were admitted to hospital did a favorable factor of CWI. Theipsilateral severe stenosis of ICA(OR=6.415,95%CI3.096~13.29, P<0.001), Theipsilateral severe stenosis of MCA(OR=2.945,95%CI1.615~5.404, P<0.001), multiplevessels stenosis(OR=3.142,95%CI1.709~5.775, P<0.001) were risk factors of CWI.3185patients of CWI were devided into three groups according to Bogousslavskyclassification,45patients (24.3%) had cortical watershed (CWS),107patients(57.8%)had internal watershed(IWS), and33patients(17.9%) had combined watershed.4Therewere no statistically significant differences about the distribution in the systolic bloodpressure, diastolic blood pressure, mean arterial pressure when they were admitted to hospital among three sub-CWI(P>0.05). The patients with cortical watershed had a moresevere stenosis of ICA(P=0.041); the patients with internal watershed had a more severestenosis of of MCA(P=0.034), cortical watershed who had severe stenosis of ICA oftenhad ipsilateral unstable carotid plagues(80.8%), there were statistically significantdifferences about lesion vessel numbers among three sub-CWI(P=0.019), combinedwatershed had multiply lesion vessel numbers.Conclusions1CWI often had severe stenosis, especially ICA and MCA. That meansits pathophysiology may associate with hemodynamic impairment.2CWS had a highdegree of ICA stenosis, IWS often had severe stenosis of MCA; cortical watershed whohad severe stenosis of ICA often had ipsilateral unstable carotid plagues, That may meansits pathophysiology may associate with hemodynamic impairment and microembolism.and combined watershed often had multiply vessel stenosis on the lesion side.3Compared with the non-CWI patients, the CWI patients had a lower blood pressure whenthey were admitted to hospital, and their symptoms were relatively mild in most patients,moderate higher blood pressure did a favorable factor of CWI.Figure6; Table17; Reference94...