Department of Neurology, Copenhagen University Hospital-Bispebjerg & Copenhagen Stroke Research Centre, Copenhagen, Denmark.
BMJ Open. 2013 Oct 21;3(10):e003724. doi: 10.1136/bmjopen-2013-003724.
We investigated the prevalence and long-term risk associated with intracranial atherosclerosis identified during routine evaluation.
This study presents data from a prospective cohort of patients admitted to our stroke unit for thrombolysis evaluation.
We included 652 with a final diagnosis of ischaemic stroke or transient ischaemic attack (TIA) from April 2009 to December 2011. All patients were acutely evaluated with cerebral CT and CT angiography (CTA). Acute radiological examinations were screened for intracranial arterial stenosis (IAS) or intracranial arterial calcifications (IAC). Intracranial stenosis was grouped into 30-50%, 50-70% and >70% lumen reduction. The extent of IAC was graded as number of vessels affected.
Patients were followed until July 2013. Recurrence of an ischaemic event (stroke, ischaemic heart disease (IHD) and TIA) was documented through the national chart system. Poor outcome was defined as death or recurrence of ischaemic event.
101 (15.5%) patients showed IAS (70: 30-50%, 29: 50-70% and 16: >70%). Two-hundred and fifteen (33%) patients had no IAC, 339 (52%) in 1-2 vessels and 102 (16%) in >2 vessels. During follow-up, 53 strokes, 20 TIA and 14 IHD occurred, and 95 patients died. The risk of poor outcome was significantly different among different extents of IAS as well as IAC (log-rank test p<0.01 for both). In unadjusted analysis IAS and IAC predicted poor outcome and recurrent ischaemic event. When adjusted, IAS and IAC independently increased the risk of a recurrent ischaemic event (IAS: HR 1.67; CI 1.04 to 2.64 and IAC: HR 1.22; CI 1.02 to 1.47).
Intracranial atherosclerosis detected during acute evaluation predicts an increased risk of recurrent stroke.
我们研究了在常规评估期间发现的颅内动脉粥样硬化的患病率和长期风险。
本研究提供了 2009 年 4 月至 2011 年 12 月期间因溶栓评估而入住我们卒中病房的患者的前瞻性队列数据。所有患者均接受了大脑 CT 和 CT 血管造影（CTA）的急性评估。急性放射学检查筛查颅内动脉狭窄（IAS）或颅内动脉钙化（IAC）。颅内狭窄分为狭窄 30-50%、50-70%和>70%管腔狭窄。IAC 的严重程度按受累血管数量分级。
患者随访至 2013 年 7 月。通过国家图表系统记录缺血性事件（中风、缺血性心脏病（IHD）和 TIA）的复发情况。不良预后定义为死亡或缺血性事件复发。
101 例（15.5%）患者出现 IAS（70 例为 30-50%、29 例为 50-70%、16 例为>70%）。215 例（33%）患者无 IAC，1-2 支血管受累 339 例，>2 支血管受累 102 例。随访期间，发生 53 例中风、20 例 TIA 和 14 例 IHD，95 例患者死亡。IAS 不同程度以及 IAC 程度不同，不良预后和复发性缺血事件的风险显著不同（log-rank 检验 p<0.01）。在未调整分析中，IAS 和 IAC 预测不良预后和复发性缺血事件。调整后，IAS 和 IAC 独立增加了复发性缺血事件的风险（IAS：HR 1.67；95%CI 1.04-2.64 和 IAC：HR 1.22；95%CI 1.02-1.47）。
急性评估期间发现的颅内动脉粥样硬化可预测中风复发风险增加。
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