椎基底动脉血流评估与短暂性脑缺血发作和卒中风险研究（VERiTAS）：研究背景和设计。
Vertebrobasilar Flow Evaluation and Risk of Transient Ischaemic Attack and Stroke study (VERiTAS): rationale and design.
机构信息
Department of Neurosurgery, Neuropsychiatric Institute, University of Illinois at Chicago, Chicago, IL 60612-5970, USA.
出版信息
Int J Stroke. 2010 Dec;5(6):499-505. doi: 10.1111/j.1747-4949.2010.00528.x.
BACKGROUND
Over one-third of ischaemic strokes occur in the posterior circulation, and a leading cause is atherosclerotic vertebrobasilar disease. Symptomatic vertebrobasilar disease carries a high annual recurrent stroke risk, averaging 10-15% per year. Endovascular angioplasty and stenting are increasingly used but carry risks, and the benefit remains unproven. Determining stroke predictors in this population is critical to identifying high-risk patients for future trials of intervention. Preliminary studies indicate that stroke risk in vertebrobasilar disease is strongly related to haemodynamic compromise, which can be measured noninvasively using quantitative magnetic resonance angiography.
METHODS/STUDY DESIGN: The Vertebrobasilar Flow Evaluation and Risk of Transient Ischaemic Attack and Stroke (VERiTAS) study, a prospective multicentre NIH-funded observational study of symptomatic vertebrobasilar stenosis (≥50%) or occlusion, is designed to test the hypothesis that patients demonstrating compromised blood flow as assessed by quantitative magnetic resonance angiography are at higher stroke risk. The study will recruit 80 patients at six sites in North America over 4-years. Upon enrollment, subjects will undergo haemodynamic assessment with blinded quantitative magnetic resonance angiography to assess large vessel flow in the vertebrobasilar territory, and be prospectively designated as compromised or normal flow. Patients will be re-imaged with quantitative magnetic resonance angiography at 6-, 12-, and 24-months, and followed for 12-24-months for the primary end-point of stroke in the vertebrobasilar territory.
CONCLUSION
The VERiTAS study is the first prospective study of haemodynamics and stroke risk in the posterior circulation. The results may impact the selection criteria for interventional candidates and also define a low-risk population in whom the risks of invasive interventions would be unnecessary.
背景
超过三分之一的缺血性中风发生在后循环中，一个主要原因是动脉粥样硬化性椎基底动脉疾病。有症状的椎基底动脉疾病每年复发中风的风险很高，平均每年为 10-15%。血管内血管成形术和支架置入术的应用越来越多，但也存在风险，其益处仍未得到证实。确定该人群中的中风预测因素对于确定未来干预试验的高危患者至关重要。初步研究表明，椎基底动脉疾病中的中风风险与血液动力学障碍密切相关，可使用定量磁共振血管造影术进行非侵入性测量。
方法/研究设计：椎基底动脉血流评估和短暂性脑缺血发作和中风风险（VERiTAS）研究是一项由美国国立卫生研究院资助的前瞻性多中心观察性研究，研究对象为有症状的椎基底动脉狭窄（≥50%）或闭塞患者，旨在检验以下假设：通过定量磁共振血管造影评估血流受损的患者中风风险较高。该研究将在北美六个地点招募 80 名患者，历时 4 年。入组时，受试者将接受血流动力学评估，采用盲法定量磁共振血管造影评估椎基底动脉区域的大血管血流，并前瞻性地指定为血流受损或正常。患者将在 6、12 和 24 个月时进行定量磁共振血管造影再成像，并在 12-24 个月时进行随访，以确定椎基底动脉区域的中风主要终点。
结论
VERiTAS 研究是对后循环血流动力学和中风风险的首次前瞻性研究。研究结果可能会影响介入候选者的选择标准，并定义一个低风险人群，在该人群中，侵入性干预的风险是不必要的。
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