Arenillas J F, Molina C A, Montaner J, Abilleira S, González-Sánchez M A, Alvarez-Sabín J
Cerebrovascular Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain.
Stroke. 2001 Dec 1;32(12):2898-904. doi: 10.1161/hs1201.099652.
Patients with symptomatic intracranial atherosclerotic stenosis have a high rate of recurrence. We conducted a prospective study to determine which factors are associated with the progression of symptomatic middle cerebral artery (MCA) stenosis and to evaluate the relationship between progression and clinical recurrence.
Between January 1996 and February 2000, of a total of 2564 consecutive first-ever transient ischemic attack (TIA) or stroke patients admitted to our cerebrovascular unit, 145 showed an MCA stenosis signal on transcranial Doppler (TCD) on admission, and 40 fulfilled all criteria to enter this study, including angiographic confirmation. Patients were prescribed antiplatelet or anticoagulant agents following the criteria of the neurologist in charge. TCD recordings and clinical interviews were performed regularly during follow-up. Progression of MCA stenosis was defined as an increase >30 cm/s in TCD-recorded maximum mean flow velocity. Logistic regression analyses were used to identify predictors of progression and clinical recurrence.
With a median follow-up of 26.55 months, 13 (32.5%) MCA stenoses progressed, 3 (7.5%) regressed, and 24 (60%) remained stable. Absence of significant extracranial internal carotid artery (ICA) stenosis (P=0.049) and the use of oral anticoagulants (P=0.045) were significantly associated with a lower progression rate in univariate analysis, and anticoagulation remained an independent predictor when a logistic regression model was applied (OR 7.25, CI 1.1 to 48.1, P=0.019). A new ischemic event during follow-up in the territory supplied by the stenosed MCA occurred in 8 cases (20%), and 13 patients had a major vascular event. Progression of the MCA stenosis detected by TCD was independently associated with a new ipsilateral ischemic event (OR 2.89, CI 1.09 to 7.71, P=0.031) and with the occurrence of any major vascular event (OR 7.03, CI 1.6 to 30.9, P=0.0071).
Progression of symptomatic MCA stenosis detected by means of TCD predicts clinical recurrence. Anticoagulation is independently associated with a lower progression rate of symptomatic MCA stenosis.
有症状的颅内动脉粥样硬化性狭窄患者复发率很高。我们进行了一项前瞻性研究，以确定哪些因素与有症状的大脑中动脉（MCA）狭窄进展相关，并评估狭窄进展与临床复发之间的关系。
在1996年1月至2000年2月期间，在我们脑血管科连续收治的2564例首次短暂性脑缺血发作（TIA）或卒中患者中，145例入院时经颅多普勒（TCD）显示有MCA狭窄信号，40例符合所有纳入本研究的标准，包括血管造影证实。按照主管神经科医生的标准为患者开具抗血小板或抗凝药物。随访期间定期进行TCD记录和临床访谈。MCA狭窄进展定义为TCD记录的最大平均流速增加>30 cm/s。采用逻辑回归分析来确定狭窄进展和临床复发的预测因素。
中位随访26.55个月，13例（32.5%）MCA狭窄进展，3例（7.5%）狭窄程度减轻，24例（60%）保持稳定。在单因素分析中，无明显的颅外颈内动脉（ICA）狭窄（P=0.049）和使用口服抗凝剂（P=0.045）与较低的狭窄进展率显著相关，应用逻辑回归模型时，抗凝仍然是一个独立的预测因素（OR 7.25，CI 1.1至48.1，P=0.019）。在随访期间，狭窄的MCA供血区域发生8例（20%）新的缺血事件，13例患者发生了重大血管事件。TCD检测到的MCA狭窄进展与新的同侧缺血事件（OR 2.89，CI 1.09至7.71，P=0.031）以及任何重大血管事件的发生（OR 7.03，CI 1.6至30.9，P=0.0071）独立相关。
通过TCD检测到的有症状的MCA狭窄进展可预测临床复发。抗凝与有症状的MCA狭窄较低的进展率独立相关。
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