Lancet Neurology:短暂性脑缺血发作或轻度脑卒中患者症状性颅内狭窄的患病率、预测因素和预后:一项基于人群的队列研究

2020-12-18 MedSci原创 MedSci原创

"脑卒中"又称"中风",是一种急性脑血管疾病,是由于脑部血管突然破裂或因血管阻塞导致血液不能流入大脑而引起脑组织损伤的一组疾病,包括缺血性和出血性卒中。

"脑卒中"又称"中风",是一种急性脑血管疾病,是由于脑部血管突然破裂或因血管阻塞导致血液不能流入大脑而引起脑组织损伤的一组疾病,包括缺血性和出血性卒中。缺血性卒中的发病率高于出血性卒中,占脑卒中总数的60%~70%。大脑大动脉的颅内动脉粥样硬化性狭窄是缺血性中风的常见原因。严重者可引起死亡。脑卒中具有发病率高、死亡率高和致残率高的特点。

症状性颅内狭窄被认为是脑卒中复发的高危因素,但是之前的两项试验(SAMMPRIS和VISSIT)并没有显示颅内狭窄支架置入术优于单纯的强化医疗治疗。这些发现部分是由于未做支架置入术的患者卒中复发风险低于预期,这可能反映了招募患者的年龄较小(中位年龄<60岁),也对常规临床实践的可推广性提出了疑问。本文主要研究一组以人群为基础的急性脑缺血发作和轻度脑卒中患者的症状性颅内狭窄的年龄特异性患病率、预测因素和预后。

(OXVASC)是一项对居住在英国牛津郡的92728人进行的所有血管事件的前瞻性发病率队列研究。所有在2011年3月1日至2018年3月1日(随访至2018年9月28日)之间发生的短暂性脑缺血发作和轻微缺血性中风的患者,不论年龄大小,均采用多种方法进行确定。影像学检查采用颅内动脉和颈动脉的MR血管造影,如果MR血管造影禁忌,则采用CT血管造影;如果CT血管造影禁忌,则采用经颅多普勒和颈动脉超声。在这项研究中,所有患者都接受了无支架的强化治疗,并对颅内血管成像的患者进行了分析,评估了截至2018年9月28日的随访期间50-99%颅内狭窄的年龄特异性患病率以及50-99%和70-99%狭窄的相关卒中风险。

1368例符合条件的颅内血管成像患者中,241例(17.6%)有(50-99%)有症状或无症状颅内狭窄。症状性颅内狭窄50-99%的患病率从70岁以下596人中的29人(4.9%)增加到90岁以上51人中的10人(19.6%)(ptrend<0.0001)。在94名症状性颅内狭窄率为50-99%的患者中,14名(14.9%)在中位随访2-8年(IQR 1.5-4.6)期间发生了复发性卒中(12例缺血性卒中和2例出血性卒中)。尽管与无颅内狭窄相比,有症状的颅内狭窄会增加缺血性卒中的风险(调整后的风险比为1.43,95%可信区间为1.04-1.96),但有70-99%有症状的颅内狭窄患者发生同区域缺血性卒中的风险往往低于先前试验中非支架组的报告风险。

综上所述,颅内狭窄在伴有轻度缺血性中风或短暂性脑缺血发作的老年高加索患者中普遍存在,且症状性颅内狭窄后复发卒中的风险与年轻人群中的两个随机对照试验(SAMMPRIS和VISSIT)相一致。考虑到试验结果可能对更广泛的患者群体具有普遍适用性,常规筛查颅内狭窄可能不足以确定支架植入的候选对象,但颅内狭窄确实可以确定动脉粥样硬化疾病风险较高的患者,这些患者可能需要跟踪或风险因素管理并招募到未来的临床试验中。

Hurford, Robert et al. Prevalence, predictors, and prognosis of symptomatic intracranial stenosis in patients with transient ischaemic attack or minor stroke: a population-based cohort study. The Lancet Neurology, Volume 19, Issue 5, 413 - 421

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2020, time=2020-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909215, encodeId=04ac9092158f, content=症状性颅内狭窄被认为是脑卒中复发的高危因素, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Fri Dec 18 19:16:20 CST 2020, time=2020-12-18, status=1, ipAttribution=)]
    2021-03-08 yinhl1978
  4. 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  5. 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2020, time=2020-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909215, encodeId=04ac9092158f, content=症状性颅内狭窄被认为是脑卒中复发的高危因素, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Fri Dec 18 19:16:20 CST 2020, time=2020-12-18, status=1, ipAttribution=)]
    2021-09-08 howi
  6. 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  7. 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2020, time=2020-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909215, encodeId=04ac9092158f, content=症状性颅内狭窄被认为是脑卒中复发的高危因素, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Fri Dec 18 19:16:20 CST 2020, time=2020-12-18, status=1, ipAttribution=)]
    2020-12-18 三生有幸9135

    症状性颅内狭窄被认为是脑卒中复发的高危因素

    0

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