Álvarez-Velasco Rodrigo, Masjuan Jaime, DeFelipe Alicia, Corral Iñigo, Estévez-Fraga Carlos, Crespo Leticia, Alonso-Cánovas Araceli
From the Neurology Department, Hospital Universitario Ramón y Cajal de Madrid, Madrid, Spain (R.A.-V., J.M., A.D.F., I.C., C.E.-F., L.C., A.A.-C.); Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain (J.M.); and Universidad de Alcalá, Madrid (J.M.).
Stroke. 2016 Apr;47(4):1117-9. doi: 10.1161/STROKEAHA.115.012637. Epub 2016 Feb 18.
Stroke on board aircraft has been reported in retrospective case series, mainly focusing on economy class stroke syndrome. Data on the actual incidence, pathogenesis, and prognosis of stroke in commercial flights are lacking.
A prospective registry was designed to include all consecutive patients referred from an international airport (40 million passengers a year) to our hospital with a diagnosis of ischemic stroke or transient ischemic attack and onset of symptoms during a flight or immediately after landing.
Forty-four patients (32 ischemic strokes and 12 transient ischemic attacks) were included over a 76-month period (January 2008 to April 2014). The estimated incidence of stroke was 1 stroke in 35 000 flights. Pathogeneses of stroke or transient ischemic attack were atherothrombotic in 16 (36%), economy class stroke syndrome in 8 (18%), cardioembolic in 7 (16%), arterial dissection in 4 (9%), lacunar stroke in 4 (9%), and undetermined in 5 (12%) patients. Carotid stenosis >70% was found in 12 (27%) of the patients. Overall prognosis was good, and thrombolysis was applied in 44% of the cases. The most common reason for not treating patients who had experienced stroke onset midflight was the delay in reaching the hospital. Only 1 patient with symptom onset during the flight prompted a flight diversion.
We found a low incidence of stroke in the setting of air travel. Economy class stroke syndrome and arterial dissection were well represented in our sample. However, the main pathogenesis was atherothrombosis with a high proportion of patients with high carotid stenosis.
回顾性病例系列报道了飞机上发生的卒中，主要聚焦于经济舱卒中综合征。商业航班中卒中的实际发病率、发病机制和预后的数据尚缺乏。
设计了一项前瞻性登记研究，纳入所有从一个国际机场（每年4000万乘客）转诊至我院，诊断为缺血性卒中和短暂性脑缺血发作，且在飞行期间或着陆后立即出现症状的连续患者。
在76个月期间（2008年1月至2014年4月）纳入了44例患者（32例缺血性卒中和12例短暂性脑缺血发作）。卒中的估计发病率为每35000次飞行中有1例卒中。卒中或短暂性脑缺血发作的发病机制为动脉粥样硬化血栓形成的有16例（36%），经济舱卒中综合征的有8例（18%），心源性栓塞的有7例（16%），动脉夹层的有4例（9%），腔隙性卒中的有4例（9%），5例（12%）患者病因未明。12例（27%）患者发现颈动脉狭窄>70%。总体预后良好，44%的病例应用了溶栓治疗。飞行途中发生卒中的患者未接受治疗的最常见原因是到达医院延迟。只有1例飞行期间出现症状的患者促使航班改道。
我们发现在航空旅行中卒中的发病率较低。我们的样本中经济舱卒中综合征和动脉夹层占比较高。然而，主要发病机制是动脉粥样硬化血栓形成，颈动脉狭窄程度高的患者比例较高。
