Stroke:在症状性颅内动脉硬化性疾病中,哪种脑梗死发生机制常见,其预后怎么样?

2020-03-01 shaosai MedSci原创

对于症状性颅内动脉硬化性疾病的患者来说,明确潜在的脑梗死发生机制有助于预防继发性脑梗死的发生。本研究旨在基于症状性颅内动脉硬化性狭窄的常规神经影像学表现建立稳定的脑梗死发生机制的分类标准,评价其临床意义。

背景与目的:
对于症状性颅内动脉硬化性疾病的患者来说,明确潜在的脑梗死发生机制有助于预防继发性脑梗死的发生。本研究旨在基于症状性颅内动脉硬化性狭窄的常规神经影像学表现建立稳定的脑梗死发生机制的分类标准,评价其临床意义。
方法
本研究纳入了前循环颅内动脉硬化性狭窄达50%-99%的患者。预先基于脑梗死形态、位置及MRA/CTA表现建立脑梗死发生机制分类标准,由两名观察者以预先设定的分类标准独立对患者病变血管进行分类:大血管动脉硬化性斑块闭塞穿支动脉、动脉栓塞、低灌注和混合机制。评价患者脑梗死发生机制与基线时患者特征及1年内相同区域复发脑梗死或相关TIA的相关性。
结果
本研究共纳入了153例患者,最常见的脑梗死发病机制为孤立性低灌注(35.3%)和动脉栓塞与低灌注混合机制(37.3%),其出现血脂异常(P=0.045)和高血压(P=0.033)的发生率要显着高于其他脑梗死发生机制。本脑梗死发生机制分类标准具有良好-很好的组间一致性和组内一致性(κ, 0.791-0.908)。整体上,共有31例患者接受介入治疗病变动脉,122例患者接受内科药物治疗。混合脑梗死发生机制的患者在相同区域1年内发生缺血性脑梗死的风险(24.4% vs. 7.8%; hazard ratio, 3.40; 95% CI, 1.25-9.20; log-rank P=0.010)要高于其他脑梗死发生机制的患者。
结论
本研究表明动脉-动脉栓塞和低灌注常常并存于颅内动脉硬化性狭窄患者中引发缺血性脑梗死,其与脑梗死复发高风险具有相关性。
原始出处:
Feng X, Chan KL, Lan L, et al,Stroke Mechanisms in Symptomatic Intracranial Atherosclerotic Disease: Classification and Clinical Implications.Stroke. 2019.DOI:10.1161/STROKEAHA.119.025732
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    2020-03-03 karmond
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    2020-03-01 肿肿

    机制研究离临床仍然有距离,不过与临床结合思考,仍然有帮助的,不能仅仅是纯临床思维,转化思维同样重要

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