Barreto-Neto Nestor, Barros Alexandre D, Jesus Pedro A P, Reis Carolina C, Jesus Morgana L, Ferreira Isadora L O, Fernandes Rodrigo D, Resende Lucas L, Andrade Alisson L, Gonçalves Beatriz M, Ventura Lais M B, Jesus Adriano A, Fonseca Luana F, Mueller Mila C, Oliveira-Filho Jamary
Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
J Stroke Cerebrovasc Dis. 2016 Jun;25(6):1417-20. doi: 10.1016/j.jstrokecerebrovasdis.2016.01.049. Epub 2016 Mar 22.
The investigation of ischemic stroke etiology is commonly limited to the heart and extracranial vessels. Nevertheless, the diagnosis of intracranial stenosis may carry important therapeutic implications. The aims of this study were to determine the prevalence and clinical predictors of intracranial atherosclerotic stenosis (ICAS) in a sample of patients with ischemic stroke.
Consecutive patients admitted to a university-based outpatient stroke clinic underwent CT angiography of the intracranial and extracranial brain vessels. Clinical, demographic, and laboratory characteristics were compared between patients with increasing levels of stenosis. Ankle-brachial index (ABI) was measured to quantify peripheral arterial disease, defined as an ABI less than or equal to .9. Multivariable ordinal logistic regression was constructed to predict increasing stenosis grades (none, 1%-49%-mild, 50%-69%-moderate, 70%-100%-severe).
We studied 106 subjects, mean age 62 ± 15 years, 54% female. ICAS was present in 38 (36%) patients: 19 (50%) mild, 7 (18%) moderate, and 12 (32%) severe. Of 74 patients where ABI was measured, low ABI was found more frequently with increasing ICAS severity (26%, 42%, 67%, and 89% of patients with none, mild, moderate, and severe ICAS, respectively). In univariable analysis, higher age, presence of diabetes, abdominal obesity, and low ABI correlated with increasing stenosis grades. In multivariable analysis, only low ABI remained independently associated with increasing stenosis grades.
The ABI is independently associated with increasing severity of ICAS, making it a potentially useful triaging tool for more invasive test selection.
缺血性中风病因的调查通常局限于心脏和颅外血管。然而，颅内狭窄的诊断可能具有重要的治疗意义。本研究的目的是确定缺血性中风患者样本中颅内动脉粥样硬化狭窄（ICAS）的患病率和临床预测因素。
连续入住大学门诊中风诊所的患者接受颅内和颅外脑血管的CT血管造影。比较狭窄程度增加的患者之间的临床、人口统计学和实验室特征。测量踝臂指数（ABI）以量化外周动脉疾病，定义为ABI小于或等于0.9。构建多变量有序逻辑回归以预测狭窄程度增加（无、1%-49%-轻度、50%-69%-中度、70%-100%-重度）。
我们研究了106名受试者，平均年龄62±15岁，54%为女性。38例（36%）患者存在ICAS：19例（50%）轻度，7例（18%）中度，12例（32%）重度。在测量ABI的74例患者中，随着ICAS严重程度的增加，低ABI的发现频率更高（分别为无、轻度、中度和重度ICAS患者的26%、42%、67%和89%）。在单变量分析中，年龄较大、患有糖尿病、腹部肥胖和低ABI与狭窄程度增加相关。在多变量分析中，只有低ABI仍然与狭窄程度增加独立相关。
ABI与ICAS严重程度的增加独立相关，使其成为一种潜在有用的分诊工具，用于选择更具侵入性的检查。
