Department of Neurology, University of California, San Francisco, CA, USA.
Stroke. 2011 Jan;42(1):44-7. doi: 10.1161/STROKEAHA.110.591099. Epub 2010 Nov 24.
clinical scores help predict outcome after transient ischemic attack (TIA), and imaging studies may improve the accuracy of predictions. Intracranial large vessel occlusion (LVO) predicts poor outcome after stroke, but the natural history of symptomatic intracranial LVO in patients with TIA is unknown.
we studied patients presenting with TIA in the STOP Stroke Study, a prospective imaging-based study of stroke outcomes. All patients underwent brain CTA. If an intracranial vascular occlusion was found in an appropriate territory to account for clinical findings, then it was judged to be a symptomatic LVO. Baseline characteristics, follow-up events, and outcomes were collected. Characteristics of patients with and without LVO were compared using χ(2) and t tests. Predictors of LVO were analyzed by univariate and multivariate analysis. LVO was assessed as a predictor of asymptomatic outcome (modified Rankin scale [mRS] score, 0), poor outcome (mRS score ≤ 3), and increase in mRS score over the study period.
of 97 patients with TIA, 13 (13%) had symptomatic intracranial LVO. Patients with LVO had higher baseline NIHSS on emergency department arrival, which was an independent predictor of LVO (OR, 1.15 per point; 95% CI, 1.02-1.29; P=0.02). Patients with LVO were more likely to have an increase in mRS score during the 90-day follow-up (P=0.03). LVO independently predicted an increase in mRS score (OR, 4.76; 95% CI, 1.23-18.43; P=0.02) and was a borderline predictor of poor outcome (mRS score ≥ 3; OR, 5.07; 95% CI, 0.92-28.03; P=0.06).
LVO is found in >1 in 10 patients presenting with TIA and predicts a decline in functional status, likely attributable to new brain ischemia.
临床评分有助于预测短暂性脑缺血发作（TIA）后的结局，而影像学研究可能会提高预测的准确性。颅内大血管闭塞（LVO）可预测中风后的不良结局，但 TIA 患者症状性颅内 LVO 的自然史尚不清楚。
我们研究了在 STOP 中风研究中出现 TIA 的患者，这是一项基于影像学的中风结局的前瞻性研究。所有患者均行脑部 CTA。如果颅内血管在适当的区域出现闭塞，与临床发现相符，则判断为症状性 LVO。收集基线特征、随访事件和结局。使用 χ(2)和 t 检验比较有和无 LVO 患者的特征。使用单变量和多变量分析分析 LVO 的预测因素。评估 LVO 作为无症状结局（改良 Rankin 量表[mRS]评分，0）、不良结局（mRS 评分≤3）和研究期间 mRS 评分增加的预测因子。
97 例 TIA 患者中，13 例（13%）存在症状性颅内 LVO。LVO 患者在急诊科到达时 NIHSS 更高，这是 LVO 的独立预测因素（OR，每增加 1 分，1.15；95%CI，1.02-1.29；P=0.02）。LVO 患者在 90 天随访期间更有可能 mRS 评分增加（P=0.03）。LVO 独立预测 mRS 评分增加（OR，4.76；95%CI，1.23-18.43；P=0.02），且是不良结局（mRS 评分≥3）的边缘预测因子（OR，5.07；95%CI，0.92-28.03；P=0.06）。
10 例 TIA 患者中就有 1 例以上存在 LVO，并且预测功能状态下降，可能归因于新的脑缺血。
