Methawasin Kulthida, Suwanwela Nijasri C, Phanthumchinda Kamnnant
J Med Assoc Thai. 2015 Oct;98 Suppl 9:S98-105.
The risk of recurrent ischemic stroke and acute coronary syndrome increased in the large artery atherosclerotic subtype. The purpose of this study was to compare 2-year outcomes between the ischemic stroke patients with intracranial arterial stenosis without significant extracranial carotid stenosis and the patients with extracranial carotid stenosis.
This study prospectively compared 123 ischemic stroke patients: 71 patients with intracranial arterial stenosis without significant extracranial carotid stenosis and 52 patients with extracranial carotid stenosis. Neurologic and radiologic investigations were performed at the beginning of the study. All of them were treated as regular outpatients of the neurology unit with a mean follow-up of 24 months. Recurrent stroke, myocardial infarction, and death were recorded.
Fifteen patients of the extracranial carotid stenosis group and eighteen patients ofthe intracranial arterial stenosis without significant extracranial carotid stenosis group developed recurrent stroke during follow-up (p = 0.40). Acute coronary syndrome occurred in eight patients of the extracranial carotid stenosis group and only one of the intracranial arterial stenosis without significant extracranial carotidstenosis group (p = 0.004). Causes of death were end stage cancers, stroke and related conditions, and acute coronary syndrome. The multivariate analysis showed that symptomatic extracranial carotid stenosis is an important risk factor of the acute coronary syndrome (p = 0.03, OR = 10.81, 95% CI 1.23-94.77).
There was no significant difference of recurrent ischemic stroke and recurrent stroke between patients with intracranial arterial stenosis without extracranial carotid stenosis and patients with extracranial carotid stenosis. On the other hand, patients with extracranial carotid stenosis had more incidences of acute coronary syndrome significantly than patients with intracranial arterial stenosis.
大动脉粥样硬化亚型中复发性缺血性中风和急性冠状动脉综合征的风险增加。本研究的目的是比较颅内动脉狭窄且无明显颅外颈动脉狭窄的缺血性中风患者与颅外颈动脉狭窄患者的2年预后。
本研究前瞻性比较了123例缺血性中风患者：71例颅内动脉狭窄且无明显颅外颈动脉狭窄的患者和52例颅外颈动脉狭窄的患者。在研究开始时进行了神经学和放射学检查。他们均作为神经内科的普通门诊患者接受治疗，平均随访24个月。记录复发性中风、心肌梗死和死亡情况。
颅外颈动脉狭窄组有15例患者，颅内动脉狭窄且无明显颅外颈动脉狭窄组有18例患者在随访期间发生复发性中风（p = 0.40）。颅外颈动脉狭窄组有8例患者发生急性冠状动脉综合征，而颅内动脉狭窄且无明显颅外颈动脉狭窄组仅有1例（p = 0.004）。死亡原因是终末期癌症、中风及相关病症和急性冠状动脉综合征。多变量分析显示，有症状的颅外颈动脉狭窄是急性冠状动脉综合征的重要危险因素（p = 0.03，OR = 10.81，95%CI 1.23 - 94.77）。
颅内动脉狭窄且无颅外颈动脉狭窄的患者与颅外颈动脉狭窄的患者在复发性缺血性中风和复发性中风方面无显著差异。另一方面，颅外颈动脉狭窄的患者发生急性冠状动脉综合征的发生率明显高于颅内动脉狭窄的患者。
