Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota 55455, USA.
J Stroke Cerebrovasc Dis. 2013 May;22(4):389-96. doi: 10.1016/j.jstrokecerebrovasdis.2011.09.017. Epub 2011 Nov 13.
Patients with spontaneous cervicocranial dissection (SCCD) may experience new or recurrent ischemic events despite antiplatelet or anticoagulant therapy. Treatment with stent placement is an available option; however, the literature on patient selection is limited. Thus, identifying patients at high risk for neurologic deterioration after SCCD is of critical importance. The present study examined the rate of neurologic deterioration in medically treated patients with SCCD and evaluated demographic, clinical, and radiologic factors affecting this deterioration. We retrospectively identified consecutive patients with SCCD over a 7-year period from 3 medical institutions, and evaluated the relationships between demographic data, clinical characteristics, and angiographical findings and subsequent neurologic outcomes. Neurologic deterioration was defined as transient ischemic attack (TIA), ischemic stroke, or death occurring during hospitalization or within 1 year of diagnosis. Kaplan-Meier curves were used to determine neurologic event-free survival up to 12 months. A total of 69 patients (mean age, 47.8 ± 14 years; 45 males) with SCCD were included in the study. Eleven patients (16%) experienced in-hospital neurologic deterioration (TIA in 9, ischemic stroke in 1) or death (1 patient). An additional 8 patients developed neurologic deterioration within 1 year after discharge (TIA in 5, ischemic stroke in 2, and death in 1). The overall 1-year event-free survival rate was 72%. Women (P = .046), patients with involvement of both vertebral arteries (P = .02), and those with intracranial arterial involvement (P = .018) had significantly higher rates of neurologic deterioration. Our findings indicate that neurologic deterioration is relatively common after SCCD despite medical treatment in women, patients with bilateral vertebral artery involvement, and those with intracranial vessel involvement.
自发性颈颅血管夹层（SCCD）患者即使接受抗血小板或抗凝治疗，也可能会出现新的或复发的缺血性事件。支架置入治疗是一种可行的选择；然而，关于患者选择的文献有限。因此，确定 SCCD 后神经功能恶化的高危患者至关重要。本研究检查了接受药物治疗的 SCCD 患者的神经功能恶化率，并评估了影响这种恶化的人口统计学、临床和影像学因素。我们回顾性地从 3 家医疗机构确定了 7 年内连续的 SCCD 患者，并评估了人口统计学数据、临床特征和血管造影结果与随后的神经结局之间的关系。神经功能恶化定义为住院期间或诊断后 1 年内发生短暂性脑缺血发作（TIA）、缺血性卒中和死亡。Kaplan-Meier 曲线用于确定 12 个月内的神经事件无事件生存率。共有 69 名（平均年龄 47.8±14 岁；45 名男性）SCCD 患者纳入本研究。11 名患者（16%）在住院期间出现神经功能恶化（9 例 TIA，1 例缺血性卒中）或死亡（1 例）。另外 8 名患者在出院后 1 年内出现神经功能恶化（5 例 TIA，2 例缺血性卒中和 1 例死亡）。总体 1 年无事件生存率为 72%。女性（P=0.046）、双侧椎动脉受累患者（P=0.02）和颅内动脉受累患者（P=0.018）神经功能恶化率显著较高。我们的研究结果表明，尽管在女性、双侧椎动脉受累和颅内血管受累的 SCCD 患者中进行了药物治疗，但神经功能恶化仍相对常见。
