Baracchini Claudio, Anzola Gian Paolo, Cenciarelli Silvia, Diomedi Marina, Bella Rita, Tonon Agnese, Braga Massimiliano, Zedde Maria Luisa, Zanferrari Carla, Del Sette Massimo, Caliandro Pietro, Gandolfo Carlo, Ricci Stefano, Meneghetti Giorgio
Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Via Giustiniani 5, 35128, Padua, Italy.
Neurologic Clinic and Rehabilitation Department, Casa di Cura Villa Barbarano, Salò, Italy.
Neurol Sci. 2016 Oct;37(10):1645-51. doi: 10.1007/s10072-016-2642-6. Epub 2016 Jun 30.
There are currently no data available on the prevalence of symptomatic intracranial atherosclerosis (ICAS) in Italy. The aim of this prospective, multicenter, hospital-based, transcranial ultrasound study was to establish the prevalence of ICAS among patients hospitalized with acute ischemic stroke. At 11 stroke centers across Italy, patients consecutively admitted for their first ever acute ischemic stroke were assessed prospectively over a 24-month period either with transcranial color-coded Doppler sonography (TCCS) or transcranial Doppler (TCD) according to validated criteria. ICAS was diagnosed when there was an evidence of a cerebral infarction in the territory of a ≥50 % stenosis detected by TCCS/TCD and confirmed by magnetic resonance angiography or computed tomography angiography. A total of 1134 patients were enrolled, 665 of them (58.6 %) men, with a mean age of 71.2 ± 13.3 years. ICAS was recorded in 99 patients (8.7 % of the whole sample, 8.9 % among Caucasians), most commonly located in the anterior circulation (63 of 99, 5.5 %). After adjusting for potential confounders, multivariate analysis identified carotid/vertebral ≥50 % stenosis [odds ratio (OR) 2.59, 95 % (confidence interval) CI 1.77-6.33; P = 0.02] and hypercholesterolemia (OR 1.38, 95 % CI 1.02-1.89; P = 0.02) as being independently associated with ICAS. ICAS is a surprisingly relevant cause of ischemic stroke in Italy, identified in almost 9 % of first-ever stroke patients. It is more prevalent in the anterior circulation and independently associated with hemodynamically significant cervical vessel atherosclerosis and hypercholesterolemia. These findings support the systematic use of transcranial ultrasound to identify ICAS in patients presenting with acute ischemic stroke and in cases with ≥50 % cervical vessel stenoses.
目前意大利尚无关于有症状性颅内动脉粥样硬化（ICAS）患病率的数据。这项前瞻性、多中心、基于医院的经颅超声研究的目的是确定急性缺血性卒中住院患者中ICAS的患病率。在意大利的11个卒中中心，对首次因急性缺血性卒中连续入院的患者，根据经过验证的标准，在24个月的时间里前瞻性地采用经颅彩色编码多普勒超声检查（TCCS）或经颅多普勒（TCD）进行评估。当TCCS/TCD检测到≥50%狭窄区域有脑梗死证据且经磁共振血管造影或计算机断层血管造影证实时，诊断为ICAS。共纳入1134例患者，其中665例（58.6%）为男性，平均年龄71.2±13.3岁。99例患者记录有ICAS（占整个样本的8.7%，白种人中占8.9%），最常见于前循环（99例中的63例，5.5%）。在对潜在混杂因素进行校正后，多变量分析确定颈动脉/椎动脉≥50%狭窄[比值比（OR）2.59，95%（置信区间）CI 1.77 - 6.33；P = 0.02]和高胆固醇血症（OR 1.38，95%CI 1.02 - 1.89；P = 0.02）与ICAS独立相关。在意大利，ICAS是缺血性卒中一个出人意料的重要病因，在几乎9%的初发卒中患者中被发现。它在前循环中更常见，并且与血流动力学上显著的颈部血管动脉粥样硬化和高胆固醇血症独立相关。这些发现支持在急性缺血性卒中患者以及颈部血管狭窄≥50%的病例中系统地使用经颅超声来识别ICAS。
