Vernieri F, Pasqualetti P, Passarelli F, Rossini P M, Silvestrini M
AFaR CRCCS: Divisione di Neurologia-Ospedale Fatebenefratelli, Isola Tiberina, Roma, Italy.
Stroke. 1999 Mar;30(3):593-8. doi: 10.1161/01.str.30.3.593.
The purpose of this study was to investigate the possibility of obtaining prognostic indications in patients with internal carotid occlusion on the basis of intracranial hemodynamic status, presence of previous symptoms of cerebrovascular failure, and baseline characteristics.
Cerebral hemodynamics were studied with transcranial Doppler ultrasonography. Cerebrovascular reactivity to apnea was calculated by means of the breath-holding index (BHI) in the middle cerebral arteries. Sixty-five patients with internal carotid artery occlusion were followed-up prospectively (median, 24 months), 23 patients were asymptomatic and 42 symptomatic (20 with transient ischemic attack and 22 with stroke).
During the follow-up period, 11 symptomatic patients and 1 asymptomatic patient had another ischemic event ipsilateral to carotid occlusion. Among factors considered, only lower BHI values in the middle cerebral arteries ipsilateral to carotid occlusion and older age were significantly associated with the risk of developing symptoms (P=0.002 and P=0.003, respectively; Cox regression multivariate analysis). Based on our data, a cut point of the BHI value for distinguishing between pathological and normal cerebrovascular reactivity was determined to be 0.69. All patients except one, who developed TIA or stroke during the follow-up period, had BHI values ipsilateral to carotid occlusion of <0.69.
These data suggest that impaired cerebrovascular reactivity is predictive for cerebral ischemic events in patients with carotid occlusion.
本研究旨在基于颅内血流动力学状态、既往脑血管功能衰竭症状的存在情况以及基线特征，探讨获得颈内动脉闭塞患者预后指标的可能性。
采用经颅多普勒超声研究脑血流动力学。通过计算大脑中动脉的屏气指数（BHI）来评估脑血管对呼吸暂停的反应性。对65例颈内动脉闭塞患者进行前瞻性随访（中位随访时间为24个月），其中23例无症状，42例有症状（20例为短暂性脑缺血发作，22例为中风）。
在随访期间，11例有症状患者和1例无症状患者在颈动脉闭塞同侧发生了另一次缺血性事件。在考虑的因素中，仅颈动脉闭塞同侧大脑中动脉较低的BHI值和较高的年龄与出现症状的风险显著相关（分别为P = 0.002和P = 0.003；Cox回归多变量分析）。根据我们的数据，确定区分病理性和正常脑血管反应性的BHI值切点为0.69。除1例在随访期间发生短暂性脑缺血发作或中风的患者外，所有患者颈动脉闭塞同侧的BHI值均<0.69。
这些数据表明，脑血管反应性受损可预测颈动脉闭塞患者的脑缺血事件。
