Stroke:基于非管腔狭窄性高危颈动脉斑块下的缺血性脑卒中分类

2020-07-11 shaosai MedSci原创

颈动脉斑块并管腔<50%可能不是脑卒中发生机制的主要原因。本研究评估经参考非管腔狭窄性高危斑块对脑卒中重新再分类的价值。

背景与目的

颈动脉斑块并管腔<50%可能不是脑卒中发生机制的主要原因。本研究评估经参考非管腔狭窄性高危斑块对脑卒中重新再分类的价值。

方法

本研究纳入了前循环梗死且行颅脑MRI、颈部MRA的患者。高危斑块是指经颈部MRA检查斑块内出血。通过DWI来明确梗死位置。采用盲法由神经放射科医师分别评估斑块内出血及梗死位置。利用McNemar检验对配对数据比较斑块内出血及颅内梗死位置的侧别性。无论颈动脉狭窄程度,将有斑块内出血且同侧出现脑梗死作为大动脉粥样硬化性脑卒中。

结果

在1721例急性缺血性脑卒中的患者中,共有579例满足该研究分析。在大动脉粥样硬化性(RR, 3.7 [95% CI, 2.2-6.1])、隐源性(RR, 2.1 [95% CI, 1.4-3.1])及心源性栓塞(RR, 1.7 [95% CI, 1.1-2.4])患者中,高危斑块在脑梗死同侧颈动脉更为常见。在腔隙性脑卒中(RR, 1.2 [95% CI, 0.4-3.5])、其他原因的脑卒中(RR, 1.5 [95% CI, 0.7-3.3])中,相对于脑梗死位置,高危斑块发生位置侧别性无显著性差异。在考虑到同侧高危斑块中,88 (15.2%)例患者发生机制改变:分别有38 (22.6%)心源性栓塞、6 (8.5%)腔隙性脑梗死、3 (15.8%)其他原因均改为多元性;41 (20.8%)隐源性脑梗死改为大动脉粥样硬化性脑梗死。

结论

颈动脉高危斑块常见于脑梗死同侧颈动脉。根据颈动脉高危斑块位置,可重新对越达15%的病例进行再分类。

原始出处:

Kamel H, Navi BB, Merkler AE et al. Reclassification of Ischemic Stroke Etiological Subtypes on the Basis of High-Risk Nonstenosing Carotid Plaque.DOI:10.1161/STROKEAHA.119.027970

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  6. [GetPortalCommentsPageByObjectIdResponse(id=1843585, encodeId=96a61843585f5, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Thu Feb 18 01:22:22 CST 2021, time=2021-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1807144, encodeId=5123180e144dd, content=<a href='/topic/show?id=245de9378aa' target=_blank style='color:#2F92EE;'>#缺血性脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79378, encryptionId=245de9378aa, topicName=缺血性脑)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLGtr9t89oicQdQSIeKmOQic1weIWfibJ7H24XnT8ic9wiaUMTnXByenuwicOj8Jib42ibHXNptnuiaKthhiaVw/132, createdBy=ac342500190, createdName=ms7524819409032184, createdTime=Sat May 01 11:22:22 CST 2021, time=2021-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893313, encodeId=31dd189331318, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Mon May 10 05:22:22 CST 2021, time=2021-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1280787, encodeId=d93c1280e87ea, content=<a href='/topic/show?id=c6ba1005490e' target=_blank style='color:#2F92EE;'>#颈动脉斑块#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100549, encryptionId=c6ba1005490e, topicName=颈动脉斑块)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7387164, createdName=zhangj7108, createdTime=Mon Jul 13 03:22:22 CST 2020, time=2020-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1330150, encodeId=bc74133015094, content=<a href='/topic/show?id=a91c5e92328' target=_blank style='color:#2F92EE;'>#斑块#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57923, encryptionId=a91c5e92328, topicName=斑块)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/4E6244DB7C1860858424437821E08291/100, createdBy=a6a52500039, createdName=ms3994565386320060, createdTime=Mon Jul 13 03:22:22 CST 2020, time=2020-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802557, encodeId=219580255ef6, content=非常感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eof7QgiaM40Cbk9nEupXmSOY1ibC6icYDYgtF7MMZoDnic7g0cyKqthJ2NLxE1WSiaib43H9DE4iaNQPFUBg/132, createdBy=9f9f5279032, createdName=李继鹏, createdTime=Sun Jul 12 06:57:04 CST 2020, time=2020-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802526, encodeId=7f9d8025261e, content=<a href='/topic/show?id=b64035999ca' target=_blank style='color:#2F92EE;'>#卒中#</a>脑卒中的精准医学。, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35999, encryptionId=b64035999ca, topicName=卒中)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Jul 11 18:43:47 CST 2020, time=2020-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026672, encodeId=d91210266e27d, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Sat Jul 11 15:22:22 CST 2020, time=2020-07-11, status=1, ipAttribution=)]
    2020-07-12 李继鹏

    非常感谢

    0

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    2020-07-11 lovetcm

    #卒中#脑卒中的精准医学。

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1843585, encodeId=96a61843585f5, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Thu Feb 18 01:22:22 CST 2021, time=2021-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1807144, encodeId=5123180e144dd, content=<a href='/topic/show?id=245de9378aa' target=_blank style='color:#2F92EE;'>#缺血性脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79378, encryptionId=245de9378aa, topicName=缺血性脑)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLGtr9t89oicQdQSIeKmOQic1weIWfibJ7H24XnT8ic9wiaUMTnXByenuwicOj8Jib42ibHXNptnuiaKthhiaVw/132, createdBy=ac342500190, createdName=ms7524819409032184, createdTime=Sat May 01 11:22:22 CST 2021, time=2021-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893313, encodeId=31dd189331318, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Mon May 10 05:22:22 CST 2021, time=2021-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1280787, encodeId=d93c1280e87ea, content=<a href='/topic/show?id=c6ba1005490e' target=_blank style='color:#2F92EE;'>#颈动脉斑块#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100549, encryptionId=c6ba1005490e, topicName=颈动脉斑块)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7387164, createdName=zhangj7108, createdTime=Mon Jul 13 03:22:22 CST 2020, time=2020-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1330150, encodeId=bc74133015094, content=<a href='/topic/show?id=a91c5e92328' target=_blank style='color:#2F92EE;'>#斑块#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57923, encryptionId=a91c5e92328, topicName=斑块)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/4E6244DB7C1860858424437821E08291/100, createdBy=a6a52500039, createdName=ms3994565386320060, createdTime=Mon Jul 13 03:22:22 CST 2020, time=2020-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802557, encodeId=219580255ef6, content=非常感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eof7QgiaM40Cbk9nEupXmSOY1ibC6icYDYgtF7MMZoDnic7g0cyKqthJ2NLxE1WSiaib43H9DE4iaNQPFUBg/132, createdBy=9f9f5279032, createdName=李继鹏, createdTime=Sun Jul 12 06:57:04 CST 2020, time=2020-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802526, encodeId=7f9d8025261e, content=<a href='/topic/show?id=b64035999ca' target=_blank style='color:#2F92EE;'>#卒中#</a>脑卒中的精准医学。, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35999, encryptionId=b64035999ca, topicName=卒中)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Jul 11 18:43:47 CST 2020, time=2020-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026672, encodeId=d91210266e27d, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Sat Jul 11 15:22:22 CST 2020, time=2020-07-11, status=1, ipAttribution=)]
    2020-07-11 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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