Background: Treatment for acute ischemic stroke due to large vessel occlusion (LVO) with mild symptoms is under discussion. Although most patients have good outcomes, some patients deteriorate and have unfavorable results. Imaging findings that predict the prognosis of LVO with mild symptoms are needed to identify patients who require treatment. In this study, we focused on watershed infarctions (WSIs), because this clinical phenomenon quite sensitively reflects changes in cerebral blood flow. The purpose of this study was to assess positive rates of WSI on MRI findings in patients with internal carotid artery (ICA) occlusion, and compare WSI-positive rates between patients divided according to their clinical course. Methods: We retrospectively collected data of 1,531 patients who presented with acute ischemic stroke between June 2006 and July 2019. Among them, we chose symptomatic ICA occlusion patients with a past history of atrial fibrillation who were treated conservatively. We divided these patients into two groups, those with maintenance or improvement in their NIHSS score after hospitalization, and those whose NIHSS score worsened. We compared WSI-positive rates between these two groups. Results: Thirty-seven of the 1,531 patients were included in this study. Of them, total NIHSS score was maintained or improved in 8 patients (group A), 3 of whom (37.5%) had internal watershed infarctions (IWIs). In group B, consisting of patients whose NIHSS score worsened by #x3e;2 at 7 days from symptom onset, 24 (82.8%) had IWIs. Group A thus had statistically lower IWI positivity rates than group B (p = 0.02). Three patients (37.5%) in group A had cortical watershed infarctions (CWIs), while 27 patients in group B (93.1%) had CWIs. Group A thus had a significantly lower CWI positivity rate than group B (p = 0.002). Conclusion: In patients with mildly symptomatic ICA occlusion, CWIs and IWIs might be key signs for predicting neurological deterioration after hospitalization.
Cerebrovasc Dis Extra 2020;10:76–83

中文翻译：

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皮质和内部分水岭梗死可能是预测伴有轻度症状的颈内动脉闭塞患者神经系统恶化的关键标志。

背景：正在讨论轻度症状大血管闭塞（LVO）引起的急性缺血性中风的治疗。尽管大多数患者预后良好，但有些患者病情恶化且预后不良。需要影像学发现来预测轻度症状LVO的预后，以识别需要治疗的患者。在这项研究中，我们集中于分水岭梗塞（WSI），因为这种临床现象非常灵敏地反映了脑血流的变化。这项研究的目的是评估颈内动脉（ICA）闭塞患者的WSI在MRI表现上的阳性率，并根据患者的临床病程比较患者之间WSI阳性率。方法：我们回顾性收集了2006年6月至2019年7月间1,531例急性缺血性卒中患者的数据。其中，我们选择了有房颤史且有保守治疗的症状性ICA闭塞患者。我们将这些患者分为两组，即住院后NIHSS评分维持或改善的患者和NIHSS评分恶化的患者。我们比较了这两组之间的WSI阳性率。结果：在这项研究中纳入了1,531名患者中的37名。其中，有8例患者（A组）维持或改善了NIHSS总评分，其中3例（37.5％）患有内部分水道梗死（IWI）。B组由症状发生7天后NIHSS评分恶化＃x3e; 2的患者组成，其中24例（82.8％）患有IWI。因此，A组的IWI阳性率在统计学上低于B组（p = 0.02）。A组中有3例患者（37.5％）发生了皮质分水岭梗死（CWI），而B组中有27例患者（93.1％）患有了CWI。因此，A组的CWI阳性率明显低于B组（p = 0.002）。结论：对于症状轻微的ICA闭塞的患者，CWI和IWI可能是预测住院后神经系统恶化的主要征象。
Cerebrovasc Dis Extra 2020; 10：76–83