Department of Neurology, University of Ulsan, Asan Medical Center, and Seoul Veterans Hospital, Song-Pa, PO Box 145, Seoul 138-600, South Korea.
Stroke. 2012 Dec;43(12):3313-8. doi: 10.1161/STROKEAHA.112.658500. Epub 2012 Nov 15.
The aim of this study was to investigate differences in risk factors and stroke mechanisms between intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS) and between anterior and posterior circulation atherosclerosis.
A multicenter, prospective, Web-based registry was performed on atherosclerotic strokes using diffusionweighted magnetic resonance imaging and magnetic resonance angiography. Stroke mechanisms were categorized as artery-to-artery embolism, in situ thrombo-occlusion, local branch occlusion, or hemodynamic impairment.
Onethousand patients were enrolled from 9 university hospitals. Age (odds ratio [OR], 1.033; 95% confidence interval [CI], 1.018-1.049), male gender (OR, 3.399; 95% CI, 2.335-4.949), and hyperlipidemia (OR, 1.502; 95% CI, 1.117-2.018) were factors favoring ECAS (vs ICAS), whereas hypertension (OR, 1.826; 95% CI, 1.274-2.618; P=0.001) and diabetes mellitus (OR, 1.490; 95% CI, 1.105-2.010; P=0.009) were related to posterior (vs anterior) circulation diseases. Metabolic syndrome was a factor related to ICAS (vs ECAS) only in posterior circulation strokes (OR, 2.433; 95% CI, 1.005-5.890; P=0.007). Stroke mechanisms included arterytoartery embolism (59.7%), local branch occlusion (14.9%), in situ thrombo-occlusion (13.7%), hemodynamic impairment (0.9%), and mixed (10.8%). Anterior ICAS was more often associated with artery-to-artery embolism (51.8% vs 34.0%) and less often associated with local branch occlusion (12.3% vs 40.4%) than posterior ICAS (P<0.001).
The prevalence of risk factors and stroke mechanisms differ between ICAS and ECAS, and between anterior and posterior circulation atherosclerosis. Posterior ICAS seems to be closely associated with metabolic derangement and local branch occlusion. Prevention and management strategies may have to consider these differences.
本研究旨在探讨颅内动脉粥样硬化（ICAS）和颅外动脉粥样硬化（ECAS）以及前后循环动脉粥样硬化之间的危险因素和卒中机制的差异。
采用基于网络的多中心前瞻性研究，对经弥散加权磁共振成像和磁共振血管造影检查的动脉粥样硬化性卒中患者进行登记。卒中机制分为动脉到动脉栓塞、原位血栓闭塞、局部分支闭塞或血液动力学障碍。
共纳入 9 所大学医院的 1000 例患者。年龄（比值比[OR]，1.033；95%置信区间[CI]，1.018-1.049）、男性（OR，3.399；95%CI，2.335-4.949）和高脂血症（OR，1.502；95%CI，1.117-2.018）是 ECAS（与 ICAS 相比）的危险因素，而高血压（OR，1.826；95%CI，1.274-2.618；P=0.001）和糖尿病（OR，1.490；95%CI，1.105-2.010；P=0.009）与后循环疾病相关。代谢综合征仅在后循环卒中与 ICAS（与 ECAS 相比）相关（OR，2.433；95%CI，1.005-5.890；P=0.007）。卒中机制包括动脉到动脉栓塞（59.7%）、局部分支闭塞（14.9%）、原位血栓闭塞（13.7%）、血液动力学障碍（0.9%）和混合机制（10.8%）。前循环 ICAS 更常与动脉到动脉栓塞（51.8%比 34.0%）相关，与局部分支闭塞（12.3%比 40.4%）较少相关，而后循环 ICAS 则相反（P<0.001）。
ICAS 和 ECAS 以及前后循环动脉粥样硬化之间的危险因素和卒中机制的发生率存在差异。后循环 ICAS 似乎与代谢紊乱和局部分支闭塞密切相关。预防和管理策略可能需要考虑这些差异。
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