Study On The Relationship Between The Middle Cerebral Artery Territory Acute Infarction Of Different Causes And Microemboli

Objective: To explore the relationship between the middle cerebral artery territory acute infarction of different causes and microemboli, further understanding of the mechanism of onset of cerebral infarction in different causes, provide the effective basis for the etiological diagnosis and treatment of cerebral infarction.Methods: Collect the data of patients with acute cerebral infarction diagnosed by department of neurology of Yan’an University Affiliated Hospital branch institute from June 2014 to June 2015.All 190 cases meet the inclusion criteria, and meet the criteria for the diagnosis of cerebrovascular diseases in the fourth national Cerebrovascular Disease Conference, The middle cerebral artery territory have acute infarction witch caused by this attack. Collect general information of all patients who meet with the inclusion criteria, including gender, age, family history of stroke, smoking, drinking, hypertension, diabetes, hyperlipidemia, atrial fibrillation, hyperhomocysteinaemia, carotid artery atherosclerosis, past history of cerebral infarction. Collect all cases of brain magnetic resonance imaging results, using Siemens Verio 3.0T MR scanner. Image processing using the machine comes with diffusion software; the acquisition sequence includes MRI, T1 WI, T2 WI, FLAIR sequence, DWI, MRA. Collect all the cases TCD microemboli monitoring results, using the VIASYS brand, specification model for the TCD Sonara/Tek, microemboli monitoring software, monitoring bilateral middle cerebral artery for 20 minutes. The judgment standard of microemboli according to the standards set out in the Ninth International Symposium on cerebral blood flow dynamics in 1995.According to the clinical data, all the cases were divided into LAA group, CE group, SAA group, SOE group and SUE group according to the TOAST classification, and compare the differences among each MES positive rate. Classification of TOAST subtypes group according to infarct artery divided into cortical branch blood supply area of infarction group and central branch blood supply area of infarction group, and compare the difference of the positive rate of MES. According to infarct location, MES positive group were divided into cortical branch and central branch infarction group, and compare the infarction site differences in the incidence. Results are analyzed by SPSS17.0 statistical software.Result:1. A total of 190 cases were collected, including 109 cases(57.4%) in LAA group, 5 cases in group CE(2.6%), 46 cases in group SAA(24.2%), 2 cases in group SOE(1.1%), and 28 cases in group SUE(14.7%).2. The age was compared by the variance analysis; the remaining items were compared by chi square test. CE group and SOE group are not in the test because of the cases is too few and the statistical error is large. Comparing among the three group, LAA group, SAA group and SUE group, gender, smoking, drinking, diabetes, hyperlipidemia, atrial fibrillation, hyperhomocysteinaemia, family history of stroke, there was no statistically significant difference(P > 0.05). Among the three groups, age, past history of cerebral infarction, hypertension, carotid artery atherosclerosis, the difference is statistically significant(P < 0.05).Comparison between the two groups on the risk factors of significant difference among the three groups, hypertension: LAA and SAA group, difference was not statistically significant(P > 0.05); SUE and LAA group, SUE and SAA group, the difference was statistically significant(P < 0.05). Carotid artery atherosclerosis: LAA and SAA group, the difference was not statistically significant(P > 0.05); LAA and SUE group, SAA and SUE group, the difference is statistically significant(P < 0.05). History of cerebral infarction: LAA and SAA group, SAA and SUE group, the difference was not statistically significant(P > 0.05); the LAA and SUE group, the difference was statistically significant(P < 0.05). Age: the LAA and SUE group, the difference has statistical significance(P < 0.05); LAA and SAA group, SAA and SUE group, the differences in no statistical significance(P > 0.05).3. Comparison of positive rates of MES in different subtypes of TOAST. A total of 190 cases, there were 5 cases(MES positive rate was 40%) in CE group and 2 cases(MES positive rate was 50%) in SOE group, they are not in the test because of the cases is too few and the statistical error is large. MES was positive in 71 of the remaining 183 patients(38.8%), LAA group MES positive in 47 cases(43.1%), SAA group MES positive in 12 cases(26.1%), SUE group MES positive in 12 cases(42.9%).The difference of the MES positive rates among the three groups was not statistically significant(P > 0.05). The difference of LAA group and SAA group MES positive rates was statistically significant(P < 0.05);the difference of LAA group and SUE group MES positive rates,SAA group and SUE group MES positive rates ware not statistically significant(P > 0.05).4. The relationship between the microemboli and the area of cerebral infarction, in the middle cerebral artery territory acute infarction area of TOAST subtypes. Respectively for comparison the positive rate of MES were compared between cortical branch infarction group and the central branch infarction group in LAA group, SAA group and SUE group. There were 12 cases of LAA patients have cortical branch and central branch infarction, not included in the comparison team, in the remaining 97 patients,the difference of MES positive rates between the cortical branch infarction(36.8%) and central branch infarction(47.6%)was not statistically significant(P > 0.05). In the SAA group,the difference of MES positive rates between the cortical branch infarction(0%) and central branch infarction(27.9 %) was not statistically significant(P > 0.05). In the SUE group,the difference of MES positive rates between the cortical branch infarction(43.5 %) and central branch infarction(33.3 %) was not statistically significant(P > 0.05).5. A total of 190 cases, to compare the incidence rate of cortical branch infarction and the incidence rate of central branch infarction, in MES positive patients. A total of 74 cases of MES positive, 40 cases(54%)with cerebral branch infarction, 23 cases(31.1%)with central branch infarction, 11(14.9%)cases both with cortical branch and central branch infarction. There was a significant difference between the incidence rate of cortical branch infarction and the incidence rate of central branch infarction(P < 0.05).Conclusion:1. In the middle cerebral artery territory acute infarction of TOAST subtypes of patients, LAA is the most common, followed by SAA, SUE, CE and SOE.2. The etiology of cerebral infarction in different age stages was different; the age of onset in LAA was higher than that of SUE. Hypertension and Carotid artery atherosclerosis are important risk factors for LAA and SAA. Patients with history of cerebral infarction in LAA were more than SUE.3. The positive rates of MES in LAA and SAA were different, and MES was more common in LAA.4. There was no significant difference in MES positive rate between the cortical branch and central branch of the cerebral infarction in the LAA group, the SAA group and the SUE group.5. In MES positive patients, the probability of infarction in the cortical branch was significantly higher than that in the central branch.