Department of Neurology, University of California, San Francisco, CA 94143-0114, USA.
Stroke. 2009 Dec;40(12):3834-40. doi: 10.1161/STROKEAHA.109.561787. Epub 2009 Oct 15.
Acute ischemic stroke due to large vessel occlusion (LVO)-vertebral, basilar, carotid terminus, middle and anterior cerebral arteries-likely portends a worse prognosis than stroke unassociated with LVO. Because little prospective angiographic data have been reported on a cohort of unselected patients with stroke and with transient ischemic attack, the clinical impact of LVO has been difficult to quantify.
The Screening Technology and Outcome Project in Stroke Study is a prospective imaging-based study of stroke outcomes performed at 2 academic medical centers. Patients with suspected acute stroke who presented within 24 hours of symptom onset and who underwent multimodality CT/CT angiography were approached for consent for collection of clinical data and 6-month assessment of outcome. Demographic and clinical variables and 6-month modified Rankin Scale scores were collected and combined with blinded interpretation of the CT angiography data. The OR of each variable, including occlusion of intracranial vascular segment in predicting good outcome and 6-month mortality, was calculated using univariate and multivariate logistic regression.
Over a 33-month period, 735 patients with suspected stroke were enrolled. Of these, 578 were adjudicated as stroke and 97 as transient ischemic attack. Among patients with stroke, 267 (46%) had LVO accounting for the stroke and 13 (13%) of patients with transient ischemic attack had LVO accounting for transient ischemic attack symptoms. LVO predicted 6-month mortality (OR, 4.5; 95% CI, 2.7 to 7.3; P<0.001). Six-month good outcome (modified Rankin Scale score <or=2) was negatively predicted by LVO (0.33; 0.24 to 0.45; P<0.001). Based on multivariate analysis, the presence of basilar and internal carotid terminus occlusions, in addition to National Institutes of Health Stroke Scale and age, independently predicted outcome.
Large vessel intracranial occlusion accounted for nearly half of acute ischemic strokes in unselected patients presenting to academic medical centers. In addition to age and baseline stroke severity, occlusion of either the basilar or internal carotid terminus segment is an independent predictor of outcome at 6 months.
由大血管闭塞（LVO）引起的急性缺血性卒中 - 椎动脉、基底动脉、颈内动脉终末段、大脑中动脉和前动脉 - 可能预示着预后比无 LVO 的卒中更差。由于很少有前瞻性血管造影数据报告关于未经选择的卒中伴短暂性脑缺血发作患者的队列，因此很难量化 LVO 的临床影响。
Screening Technology and Outcome Project in Stroke Study 是一项在 2 家学术医疗中心进行的基于影像学的卒中预后前瞻性研究。对发病 24 小时内接受多模态 CT/CT 血管造影的疑似急性卒中患者进行入组，以获得临床数据的同意并进行 6 个月的预后评估。收集人口统计学和临床变量以及 6 个月时的改良 Rankin 量表评分，并结合 CT 血管造影数据的盲法解读。使用单变量和多变量逻辑回归计算每个变量（包括颅内血管节段闭塞）预测良好预后和 6 个月死亡率的优势比（OR）。
在 33 个月的时间内，共纳入了 735 例疑似卒中患者。其中，578 例被判定为卒中，97 例为短暂性脑缺血发作。在卒中患者中，267 例（46%）有 LVO 导致的卒中，13 例（13%）短暂性脑缺血发作患者有 LVO 导致的短暂性脑缺血发作症状。LVO 预测 6 个月死亡率（OR，4.5；95%CI，2.7 至 7.3；P<0.001）。6 个月时的良好预后（改良 Rankin 量表评分<或=2）被 LVO 负性预测（0.33；0.24 至 0.45；P<0.001）。基于多变量分析，基底动脉和颈内动脉终末段的闭塞，以及 NIHSS 评分和年龄，独立预测了预后。
在未选择的就诊于学术医疗中心的患者中，近一半的急性缺血性卒中由颅内大血管闭塞引起。除了年龄和基线卒中严重程度外，基底动脉或颈内动脉终末段的闭塞是 6 个月时结局的独立预测因素。
