Wong Ka Sing, Li Huan
Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR.
Stroke. 2003 Oct;34(10):2361-6. doi: 10.1161/01.STR.0000089017.90037.7A. Epub 2003 Aug 28.
The goal of this study was to document the long-term outcome of ischemic stroke patients in a population with predominant intracranial atherosclerosis and risk factors for a recurrent event.
Intracranial and extracranial arteries of consecutive patients with acute ischemic stroke were studied prospectively with transcranial Doppler and duplex ultrasound. All patients were followed up regularly for the development of recurrent stroke, cardiac event, or death.
We included 705 patients with acute ischemic stroke, of whom 345 were documented ultrasonographically as having large-artery lesions. The follow-up period was up to 42 months (mean, 28+/-5 months). One hundred seventeen patients (17%) died of any cause, and 199 (28%) suffered further cerebrovascular cardiac events. The 3.5-year cumulative mortality rate was 20.8%; for cerebrovascular event, it was 29.5%. The annual recurrent stroke rates during the first year were 10.9% for patients without vascular lesion, 17.1% for intracranial atherosclerosis only, and 24.3% for both intracranial and extracranial atherosclerosis; for the second year, the rates were 7.5%, 8.6%, and 7.7%, respectively. More occurrence of death (log rank, 5.19; P=0.02) or cerebrovascular event (log rank, 9.68; P=0.002) was found among patients with than those without vascular lesions. Patients with both intracranial and extracranial arterial lesions were at highest risk of death (log rank, 9.64; P=0.008) and cerebrovascular event (log rank, 11.56; P=0.003). When death and further vascular event were combined as poor outcomes in a Cox proportional-hazards regression model, number of abnormal arteries, advanced age, diabetes, atrial fibrillation, and previous stroke were significant predictors.
Patients with intracranial atherosclerosis, especially coexisting extracranial carotid disease, are at higher risk of suffering death or further vascular event. Our findings provide important data for planning future randomized clinical trials for this high-risk group of stroke patients.
本研究旨在记录颅内动脉粥样硬化为主且有复发事件风险因素的缺血性卒中患者的长期预后。
对连续的急性缺血性卒中患者的颅内和颅外动脉进行前瞻性经颅多普勒和双功超声研究。所有患者均定期随访复发性卒中、心脏事件或死亡的发生情况。
我们纳入了705例急性缺血性卒中患者，其中345例经超声检查记录有大动脉病变。随访期长达42个月（平均28±5个月）。117例患者（17%）死于任何原因，199例（28%）发生了进一步的脑血管或心脏事件。3.5年累积死亡率为20.8%；脑血管事件累积发生率为29.5%。无血管病变患者第一年的年复发性卒中率为10.9%，仅颅内动脉粥样硬化患者为17.1%，颅内和颅外动脉粥样硬化患者为24.3%；第二年的发生率分别为7.5%、8.6%和7.7%。有血管病变的患者比无血管病变的患者死亡（对数秩检验，5.19；P=0.02）或脑血管事件（对数秩检验，9.68；P=0.002）的发生率更高。颅内和颅外动脉病变患者死亡（对数秩检验，9.64；P=0.008）和脑血管事件（对数秩检验，11.56；P=0.003）的风险最高。在Cox比例风险回归模型中，将死亡和进一步的血管事件合并为不良结局时，异常动脉数量、高龄、糖尿病、心房颤动和既往卒中是显著的预测因素。
颅内动脉粥样硬化患者，尤其是合并颅外颈动脉疾病的患者，死亡或发生进一步血管事件的风险更高。我们的研究结果为规划针对这一高危卒中患者群体的未来随机临床试验提供了重要数据。
