Department of Neurology, University of California, San Francisco, CA, USA.
Stroke. 2013 May;44(5):1310-6. doi: 10.1161/STROKEAHA.111.672741. Epub 2013 Mar 19.
Computed tomography angiography is an accurate noninvasive method to diagnose intracranial steno-occlusive disease (ICAD) at initial presentation for stroke. We aimed to identify features of computed tomography angiography associated with unfavorable outcome.
We identified patients with ICAD in the Screening Technology and Outcomes Project in Stroke Study, a prospective imaging-based study of stroke outcomes, in consecutive patients with ischemic stroke or transient ischemic attack (TIA) presenting to 2 academic medical centers. All patients underwent computed tomography angiography, which were graded by 2 neuroradiologists independently. Univariate and multiple logistic regression was used to evaluate predictors of favorable outcome at 6 months, defined as a modified Rankin Scale ≤ 2.
Among 539 patients that met study entry criteria, ICAD was identified in 212 patients (39%); 116 patients (22%) had concurrent extraintracranial lesions, and 66 patients (12%) had multiple sites of ICAD. Patients with ICAD had more severe stroke (median National Institutes of Health Stroke Scale, 9 versus 3; P<0.001), worse outcomes at 6 months (modified Rankin Scale, 0-2; 57% versus 73%; P<0.001), and higher mortality (18% versus 8%; P=0.001). In the multivariate model, age (odds ratio [OR], 0.75 per decade; 95% confidence interval [CI], 0.65-0.87), female sex (OR, 0.49; 95% CI, 0.32-0.73), multiple sites of ICAD (OR, 0.53; 95% CI, 0.29-0.97), complete occlusion (OR, 0.42; 95% CI, 0.25-0.72), and concurrent extraintracranial lesions (OR, 0.51; 95% CI, 0.31-0.84) negatively predicted favorable outcome.
Findings of multiple sites of ICAD from computed tomography angiography, concurrent extraintracranial lesions, and complete occlusion are independent predictors of unfavorable outcome at 6 months.
计算机断层血管造影术（CTA）是一种准确的非侵入性方法，可在初始表现为中风的情况下诊断颅内狭窄闭塞性疾病（ICAD）。我们旨在确定与不良结局相关的 CTA 特征。
我们在一项基于影像学的卒中预后 Screening Technology and Outcomes Project in Stroke 研究中，确定了 2 家学术医疗中心连续就诊的缺血性卒中和短暂性脑缺血发作（TIA）患者中的 ICAD 患者。所有患者均接受 CTA 检查，由 2 位神经放射科医生独立评分。使用单变量和多变量逻辑回归来评估 6 个月时有利结局的预测因素，定义为改良 Rankin 量表≤2。
在符合研究入组标准的 539 例患者中，212 例（39%）患者存在 ICAD；116 例（22%）患者存在颅外病变，66 例（12%）患者存在多处 ICAD。ICAD 患者的卒中更严重（中位数国立卫生研究院卒中量表评分，9 分比 3 分；P<0.001），6 个月时结局更差（改良 Rankin 量表评分，0-2 分比 73%；P<0.001），死亡率更高（18%比 8%；P=0.001）。在多变量模型中，年龄（每 10 年的优势比[OR]，0.75；95%置信区间[CI]，0.65-0.87）、女性（OR，0.49；95% CI，0.32-0.73）、多处 ICAD（OR，0.53；95% CI，0.29-0.97）、完全闭塞（OR，0.42；95% CI，0.25-0.72）和并发颅外病变（OR，0.51；95% CI，0.31-0.84）与不良结局呈负相关。
CTA 显示多处 ICAD、并发颅外病变和完全闭塞是 6 个月时不良结局的独立预测因素。
