Clinical And Imaging Analysis In Patients With Different Types Of Cerebral Watershed Infarction

Objective: To observe early clinical prognosis, DWI and extra-intracranial vascular stenoses in patients with the different types of cerebral watershed infarction(CWI). The relationships between the CWI types and vascular stenosis, the CWI types and early clinical outcome were analyzed. The results might provide theoretical basis for individual treatment and prevention.Methods: CWI patients were recruited, whose atrack was within 7 days and magnetic resonance imaging(MRI) including diffusion weighted imaging(DWI)were completed. According to imagine pattern on DWI, the patients were divided into three groups: cortical watershed infarction(CWSI), internal watershed infarction(IWSI), and mixed-type watershed infarction(MWSI). The general information were recorded, including age, sex, the history of hypertension, diabetes mellitus, coronary heart disease, stroke, smoking and drinking. On admission, blood pressure was examined; fast blood glucose and lipids were tested. All patients underwent the extracranial internal carotid artery(ICA) ultrasonography and intracranial cerebral vascular MRA examinations. NIHSS score on admission and 14 days after admission were achieved. Modified rankin scale were conducted 14 days after admission. The relationships between the CWI types and vascular stenosis, the CWI types and early clinical outcome were analyzed.Results: 1. Of the 120 CWI patients, there were 18 CWSI, 48 IWSI and 54 MWSI. There were no statistically significant difference in the three groups of age,sex, the history of hypertension, diabetes mellitus, coronary heart disease, stroke,smoking and drinking(P > 0.05), as well as admission blood pressure, fast glucose and lipids(P > 0.05).2. Of the 120 CWI patients, the vascular stenosis ipsilateral to the lesions was as followed: ICA 48 cases(40.0%, including extracranial segment 22 cases and internal segment 39 cases), ACA 24 cases(20.0%), MCA 86 cases(71.7%), PCA 40 cases(33.3%), vertebral basilar artery 35 cases(29.2%), ICA + MCA 36 cases(30.0%).There were different in the incidence of the lesion side ICA stenosis in the different types of CWI; There were different in the incidence of the lesion side MCA stenosis in the different types of CWI; There were also different in the incidence of the lesion side ICA+MCA stenoses in the different types of CWI.3. CWSI often combined with the ICA stenosis ipsilateral to the lesions(OR,0.022;95% CI,0.002 to 0.230;P=0.001); IWSI often combined with the MCA stenosis ipsilateral to the lesions(OR,40.164;95% CI,3.861 to 417.810; P=0.002).MWSI often combined with the MCA stenosis ipsilateral to the lesions(OR,9.586;95% CI,2.776 to 33.126;P=0.000). MWSI often combined with the ICA+MCA stenoses ipsilateral to the lesions(OR,7.481;95% CI,2.541 to22.022;P=0.000).4. There were statistically significant difference within the incidence that the lesion side with small cortical infarction and/or deep perforators infarction in the different types of CWI(P<0.05). The incidence of the lesion side with small cortical infarction in CWSI was higher than others; the incidence of the lesion side with deep perforators infarction in IWSI was higher than others; the incidence of the lesion side with small cortical infarction and deep perforators infarction in MWSI was higher than others.5. There were statistically significant difference in the clinical outcome and prognosis during the first 14 days in the different types of CWI(P < 0.05). The clinical outcome during the first 14 days in the 3 groups: the incidence of improving in CWSI was higher than others; the incidence of stable in IWSI was higher than others; the incidence of deteriorated in MWSI was higher than others. The incidence of good prognosis within CWSI was higher than others; the incidence of poorprognosis within MWSI was higher than others.Conclusion: 1.There were different in the incidence of the lesion side ICA stenosis in the different types of CWI; There were different in the incidence of the lesion side MCA stenosis in the different types of CWI; There were also different in the incidence of the lesion side ICA+MCA stenoses in the different types of CWI.The incidence of the lesion side ICA stenosis were higher in CWSI; The incidence of the lesion side MCA stenosis were higher in IWSI; The incidence of the lesion side ICA + MCA stenoses were higher in MWSI.2. There were different of the incidence that the lesion side with small cortical infarction and/or deep perforators infarction in the different types of CWI. The incidence of the lesion side with small cortical infarction in CWSI was higher; the incidence of the lesion side with deep perforators infarction in IWSI was higher; the incidence of the lesion side with small cortical infarction and deep perforators infarction in MWSI was higher.3. There were different of the early clinical outcome in different types of CWI.The incidence of improving in CWSI was higher; the incidence of stable in IWSI was higher; the incidence of deteriorated in MWSI was higher. The incidence of good prognosis in CWSI was higher; the incidence of poor prognosis in MWSI was higher.