Arauz Antonio, Calleja Juan, Vallejo Enrique, Quintero Lisveth
Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico.
Clin Neurol Neurosurg. 2010 Oct;112(8):658-61. doi: 10.1016/j.clineuro.2010.04.019. Epub 2010 May 26.
The relationships between single (SLI) and multiple lacunar infarcts (MLI) and occult coronary artery disease (CAD) have not yet been sufficiently evaluated. We aimed to investigate the prevalence of silent CAD in patients with SLI, MLI and large vessel disease (LVD) stroke, and to identify factors associated with its presence.
We enrolled 125 patients who had suffered their first non-cardioembolic ischemic stroke but had no documented history of CAD. According to their pathologies, these patients were assigned to one of three groups: MLI (n=21), SLI (n=50) or LVD (n=54). Asymptomatic CAD was detected by myocardial perfusion SPECT imaging.
Silent CAD was detected in 40 patients (32% of the total); of those that experienced CAD, 15 (30%) were from the SLI group, 7 (33%) had MLI, and 18 (33%) had an LVD stroke. Differences between the groups were not significant. During a median follow-up of 48 months, the overall stroke recurrence was 8.8%; the stroke recurrence rates for each subgroup were 6% in patients with SLI, 7% in LVD and 19% in MLI. Mortality was higher in patients from the MLI and LVD groups (26% and 14%, respectively) than in those from the SLI group (6%; p=0.02). We found no relationships between the various risk factors and silent CAD.
In this exploratory study, SPECT imaging results revealed that the prevalence of abnormal myocardial perfusion was similar in patients with either single or multiple lacunar infarcts and those that had experienced large vessel disease stroke.
单发腔隙性梗死（SLI）、多发腔隙性梗死（MLI）与隐匿性冠状动脉疾病（CAD）之间的关系尚未得到充分评估。我们旨在调查SLI、MLI和大血管疾病（LVD）性卒中患者中无症状CAD的患病率，并确定与其存在相关的因素。
我们纳入了125例首次发生非心源性缺血性卒中但无CAD记录病史的患者。根据其病理情况，这些患者被分为三组之一：MLI组（n = 21）、SLI组（n = 50）或LVD组（n = 54）。通过心肌灌注SPECT成像检测无症状CAD。
40例患者（占总数的32%）检测到无症状CAD；在那些患有CAD的患者中，15例（30%）来自SLI组，7例（33%）患有MLI，18例（33%）发生LVD性卒中。各组之间的差异不显著。在中位随访48个月期间，总体卒中复发率为8.8%；各亚组的卒中复发率分别为SLI患者中的6%、LVD患者中的7%和MLI患者中的19%。MLI组和LVD组患者的死亡率（分别为26%和14%）高于SLI组患者（6%；p = 0.02）。我们未发现各种危险因素与无症状CAD之间存在关联。
在这项探索性研究中，SPECT成像结果显示，单发或多发腔隙性梗死患者与发生大血管疾病性卒中患者的心肌灌注异常患病率相似。
