孤立性症状性颈动脉闭塞患者复发性卒中及再通的相关因素。
Factors associated with recurrent stroke and recanalization in patients presenting with isolated symptomatic carotid occlusion.
作者信息
Damania D, Kung N T-M, Jain M, Jain A R, Liew J A, Mangla R, Koch G E, Sahin B, Miranpuri A S, Holmquist T M, Replogle R E, Benesch C G, Kelly A G, Jahromi B S
机构信息
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
出版信息
Eur J Neurol. 2016 Jan;23(1):127-32. doi: 10.1111/ene.12819. Epub 2015 Sep 1.
BACKGROUND AND PURPOSE
Patients with symptomatic internal carotid artery (ICA) occlusion constitute a small proportion of stroke/transient ischaemic attack patients who are at increased risk of early stroke recurrence and poor outcome. The optimal medical treatment for patients with symptomatic ICA occlusion who are ineligible for thrombolysis or thrombectomy is unknown.
METHODS
Consecutive patients presenting at a single center with newly diagnosed symptomatic ICA occlusion (not involving the circle of Willis) were retrospectively reviewed. Those treated with intravenous thrombolysis or intra-arterial thrombolysis/thrombectomy were excluded. Patients were divided into two groups based on whether they experienced recurrent in-hospital stroke.
RESULTS
The selected study population (n = 33) represented a small (20.4%) proportion of all newly symptomatic carotid occlusions, who nevertheless had an elevated risk of recurrent stroke during admission (24.2%). Of the variables examined (age, gender, admission National Institutes of Health Stroke Scale score, vascular risk factors, atrial fibrillation, prior stroke/transient ischaemic attack and anticoagulation within 48 h of presentation), only anticoagulation was significantly associated with a lower risk of in-hospital recurrent stroke. Anticoagulated patients showed a decreased incidence of stroke recurrence within the first week (6.7% vs. 38.9%, P = 0.032) and fewer strokes or deaths at 1 month (13.3% vs. 47.1%, P = 0.040). Hemorrhagic transformation was not observed in any patient. On follow-up imaging, ICA recanalization was significantly more frequent in anticoagulated patients (46.2% vs. 9.1%, P = 0.047).
CONCLUSION
Patients with newly diagnosed symptomatic ICA occlusion (not involving the circle of Willis) represent a small but high risk subgroup of patients with carotid occlusion. Early anticoagulation was associated with fewer recurrent strokes and increased ICA recanalization. Larger scale prospective studies may be justified.
背景与目的
有症状的颈内动脉（ICA）闭塞患者在中风/短暂性脑缺血发作患者中占比小，但早期中风复发风险和预后不良风险增加。对于不符合溶栓或取栓条件的有症状ICA闭塞患者，最佳药物治疗方案尚不清楚。
方法
回顾性分析在单一中心新诊断为有症状ICA闭塞（不涉及Willis环）的连续患者。排除接受静脉溶栓或动脉内溶栓/取栓治疗的患者。根据患者住院期间是否发生复发性中风分为两组。
结果
选定的研究人群（n = 33）占所有新出现症状性颈动脉闭塞患者的比例较小（20.4%），但住院期间复发性中风风险较高（24.2%）。在所检查的变量（年龄、性别、入院时美国国立卫生研究院卒中量表评分、血管危险因素、心房颤动、既往中风/短暂性脑缺血发作以及就诊后48小时内的抗凝治疗）中，只有抗凝治疗与较低的住院复发性中风风险显著相关。接受抗凝治疗的患者在第一周内中风复发率降低（6.7%对38.9%，P = 0.032），1个月时中风或死亡人数减少（13.3%对47.1%，P = 0.040）。未观察到任何患者发生出血性转化。在随访影像学检查中，接受抗凝治疗的患者ICA再通明显更频繁（46.2%对9.1%，P = 0.047）。
结论
新诊断为有症状ICA闭塞（不涉及Willis环）的患者是颈动脉闭塞患者中占比小但风险高的亚组。早期抗凝治疗与较少的复发性中风和增加的ICA再通相关。可能有必要开展更大规模的前瞻性研究。
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