Shin Dong Hoon, Lee Phil Hyu, Bang Oh Young
Department of Neurology, School of Medicine, Ajou University, Suwon, South Korea.
Arch Neurol. 2005 Aug;62(8):1232-7. doi: 10.1001/archneur.62.8.1232.
Information on the mechanism of recurrent stroke may help physicians treating patients with ischemic stroke. However, the mechanisms of recurrence in each stroke subtype are not well known, especially in Asians.
To compare the mechanisms of the index and recurrent stroke.
Analysis of data from a prospective acute stroke registry.
University hospital.
Using the clinical syndrome, diffusion-weighted imaging, and vascular studies, we divided 901 patients into 5 groups: large-artery atherosclerosis, cardioembolism, small-artery disease, parent-artery disease occluding the deep perforators, and no determined cause. The patients with large-artery atherosclerosis were subdivided into 2 groups: intracranial and extracranial.
The mechanisms of recurrent vascular events (strokes or coronary heart disease) in subtypes of ischemic stroke were compared.
Ninety-three recurrent vascular events (86 strokes and 7 instances of coronary heart disease) were evaluated. The pattern of recurrent stroke differed for the intracranial and extracranial groups; unlike the patients with intracranial large-artery atherosclerosis, recurrent strokes in the extracranial group were often unpredictable with respect to the site of recurrence and degree of preexisting stenosis. None of the patients in the extracranial group had recurrences that were caused by intracranial large-artery atherosclerosis or vice versa. In patients with small-artery disease and stroke with no determined cause, intracranial stenosis was often found at the time of recurrence.
From prognostic and therapeutic perspectives, patients with atherosclerosis should be divided into those with intracranial large-artery atherosclerosis and extracranial large-artery atherosclerosis. In addition, intracranial large-artery atherosclerosis may be important in the development of small-artery disease and stroke with no determined cause, especially in the population with a higher frequency of intracranial large-artery atherosclerosis.
复发性卒中机制的相关信息可能有助于治疗缺血性卒中患者的医生。然而，每种卒中亚型的复发机制尚不明确，尤其是在亚洲人群中。
比较首次卒中和复发性卒中的机制。
对前瞻性急性卒中登记数据进行分析。
大学医院。
利用临床综合征、弥散加权成像和血管研究，我们将901例患者分为5组：大动脉粥样硬化、心源性栓塞、小动脉疾病、闭塞深穿支的母动脉疾病以及病因未明。大动脉粥样硬化患者又细分为2组：颅内和颅外。
比较缺血性卒中各亚型中复发性血管事件（卒中或冠心病）的机制。
评估了93例复发性血管事件（86例卒中，7例冠心病）。颅内和颅外组的复发性卒中模式不同；与颅内大动脉粥样硬化患者不同，颅外组复发性卒中的复发部位和既往狭窄程度往往不可预测。颅外组患者无一例复发是由颅内大动脉粥样硬化引起，反之亦然。在小动脉疾病和病因未明的卒中患者中，复发时经常发现颅内狭窄。
从预后和治疗角度来看，动脉粥样硬化患者应分为颅内大动脉粥样硬化和颅外大动脉粥样硬化患者。此外，颅内大动脉粥样硬化在小动脉疾病和病因未明的卒中发生中可能起重要作用，尤其是在颅内大动脉粥样硬化发生率较高的人群中。
