Paciaroni Maurizio, Caso Valeria, Venti Michele, Milia Paolo, Kappelle L Jaap, Silvestrelli Giorgio, Palmerini Francesco, Acciarresi Monica, Sebastianelli Michela, Agnelli Giancarlo
Stroke Unit, Department of Neuroscience, University of Perugia, Ospedale Silvestrini, Perugia, Italy.
Cerebrovasc Dis. 2005;20(2):108-13. doi: 10.1159/000086800. Epub 2005 Jul 5.
The clinical outcome in patients with stroke associated with internal carotid artery (ICA) occlusion is poor, although a minority may recover without dependency. The purposes of this study were (1) to assess the predictive factors of adverse outcome in patients with stroke associated with an occlusion of the ICA and (2) to evaluate the rate of spontaneous recanalization of an occluded ICA.
A total of 177 consecutive patients with first-ever ischemic stroke associated with ICA occlusion were prospectively examined from the Perugia Stroke Registry. Mean age was 71.4 +/- 14.3 years; 53% were males. Multiple regression models were used to analyze predictors of mortality, dependency and ipsilateral stroke recurrence.
The most probable cause of occlusion was atherosclerosis in 65%, cardioembolism in 22%, dissection in 9% and other causes in 4%. Thirty percent of the patients died within 30 days. After a mean follow-up of 420 days (range 1-1,970 days), 45% of the patients had died and 75% had died or were disabled. Another 6% of the patients had a recurrent stroke ipsilateral to the occluded carotid artery. Age was the only predictor of 30-day mortality (77.7 +/- 9.7 vs. 68.7 +/- 15.2 years; p = 0.03) and of long-term mortality or disability (p < 0.003). Hypertension (OR 0.42; 95% CI 0.17-1.00; p = 0.05) was associated with a better outcome within 30 days from stroke onset. Previous ipsilateral transient ischemic attack (OR 0.24; 95% CI 0.06-0.89; p = 0.03) and hyperlipidemia (OR 0.38; 95% CI 0.15-0.99; p = 0.049) were predictors of a better outcome with respect to long-term mortality or disability. No predictors of ipsilateral stroke recurrence were found. One hundred and five out of 177 patients had adequate follow-up ultrasound data. After a mean follow-up of 1.8 years, 10 patients had recanalization of the occluded ICA (2/71 atherosclerosis, 3/19 cardioembolism and 5/15 dissection).
After a mean follow-up of 1.2 years, 45% of the patients with stroke associated with ICA occlusion had died, while 75% had died or were functionally dependent. The presence of either previous ipsilateral transient ischemic attack, hypertension or hyperlipidemia was associated with a favorable outcome. Recanalization of an occluded ICA occurred in a minority of patients and it was associated with cardioembolism and with arterial dissection.
尽管少数患者可能恢复且无需依赖他人，但颈内动脉（ICA）闭塞相关的卒中患者临床预后较差。本研究的目的是：（1）评估ICA闭塞相关卒中患者不良预后的预测因素；（2）评估闭塞ICA的自发再通率。
从佩鲁贾卒中登记处前瞻性检查了177例首次发生的与ICA闭塞相关的缺血性卒中患者。平均年龄为71.4±14.3岁；53%为男性。采用多元回归模型分析死亡率、依赖程度和同侧卒中复发的预测因素。
最可能的闭塞原因是动脉粥样硬化（65%）、心源性栓塞（22%）、夹层（9%）和其他原因（4%）。30%的患者在30天内死亡。平均随访420天（范围1 - 1970天）后，45%的患者死亡，75%的患者死亡或致残。另有6%的患者在闭塞颈动脉同侧发生复发性卒中。年龄是30天死亡率（77.7±9.7岁对68.7±15.2岁；p = 0.03）和长期死亡率或残疾的唯一预测因素（p < 0.003）。高血压（OR 0.42；95%CI 0.17 - 1.00；p = 0.05）与卒中发作后30天内较好的预后相关。既往同侧短暂性脑缺血发作（OR 0.24；95%CI 0.06 - 0.89；p = 0.03）和高脂血症（OR 0.38；95%CI 0.15 - 0.99；p = 0.049）是长期死亡率或残疾方面较好预后的预测因素。未发现同侧卒中复发的预测因素。177例患者中有105例有充分的随访超声数据。平均随访1.8年后，10例患者闭塞的ICA实现再通（动脉粥样硬化71例中的2例，心源性栓塞19例中的3例，夹层15例中的5例）。
平均随访1.2年后，45%的ICA闭塞相关卒中患者死亡，75%的患者死亡或功能依赖。既往同侧短暂性脑缺血发作、高血压或高脂血症的存在与良好预后相关。少数患者发生闭塞ICA再通，且与心源性栓塞和动脉夹层有关。
