Yamauchi H, Fukuyama H, Nagahama Y, Nabatame H, Shio H
Department of Neurology, Faculty of Medicine, Kyoto University, Japan.
Rinsho Shinkeigaku. 1999 May;39(5):513-9.
In internal carotid artery occlusion, patients with inadequate blood supply relative to metabolic demand (misery perfusion) may be at increased risk for cerebral ischemia. This study investigated whether patients demonstrating misery perfusion on positron emission tomography (PET) have a high risk of subsequent stroke in symptomatic internal carotid artery occlusion.
We prospectively evaluated the relationship between the regional hemodynamic status of cerebral circulation and the subsequent risk of stroke in 40 patients with symptomatic internal carotid artery occlusion who underwent PET. Patients were divided into two hemodynamic categories according to the mean hemispheric value of oxygen extraction fraction (OEF) in the hemisphere supplied by the artery with symptomatic disease: patients with increased OEF and those with normal OEF. All patients were followed with medical treatment until the recurrence of stroke or death for 3 years.
The three-year incidence of ipsilateral ischemic strokes for patients with normal OEF and those with increased OEF were 1 of 34 and 3 of 6 patients, respectively. A significantly higher incidence of ipsilateral strokes was found in patients with increased OEF (Kaplan-Meier analysis and log-rank test; p < 0.001). Multivariate analysis with the Cox proportional hazards model demonstrated that increased OEF significantly increased stroke recurrence: the relative risk was 19.5 (95% CI, 2.0-188.6) for ipsilateral stroke. An increase in the absolute OEF value was a better predictor of recurrent ischemic stroke than an OEF asymmetry.
These findings suggest that patients with symptomatic internal carotid artery occlusion and misery perfusion have a high risk for subsequent stroke. Thus, identification and optimal treatment of patients with misery perfusion may be essential in preventing stroke.
在颈内动脉闭塞时，相对于代谢需求血供不足（灌注不良）的患者可能有更高的脑缺血风险。本研究调查了在正电子发射断层扫描（PET）中显示灌注不良的症状性颈内动脉闭塞患者发生后续卒中的风险是否较高。
我们前瞻性评估了40例接受PET检查的症状性颈内动脉闭塞患者脑循环的局部血流动力学状态与后续卒中风险之间的关系。根据有症状疾病的动脉所供血半球的氧摄取分数（OEF）的平均半球值，将患者分为两个血流动力学类别：OEF升高的患者和OEF正常的患者。所有患者接受药物治疗随访3年，直至卒中复发或死亡。
OEF正常的患者和OEF升高的患者同侧缺血性卒中的三年发生率分别为34例中的1例和6例中的3例。在OEF升高的患者中发现同侧卒中的发生率显著更高（Kaplan-Meier分析和对数秩检验；p<0.001）。使用Cox比例风险模型进行多变量分析表明，OEF升高显著增加卒中复发：同侧卒中的相对风险为19.5（95%CI，2.0-188.6）。OEF绝对值的增加比OEF不对称性更能预测复发性缺血性卒中。
这些发现表明，症状性颈内动脉闭塞和灌注不良的患者有较高的后续卒中风险。因此，识别和优化治疗灌注不良的患者对于预防卒中可能至关重要。
