Larsson Susanna C, King Alice, Madigan Jeremy, Levi Christopher, Norris John W, Markus Hugh S
From the Stroke Research Group (S.C.L., H.S.M.), Department of Clinical Neurosciences, University of Cambridge; Primary Care and Public Heath (A.K.), School of Public Health, Imperial College London; Neuroradiology (J.M.), Atkinson Morley Neuroscience Centre, St. George's Healthcare Foundation Trust, London, UK; Department of Neurology (C.L.), John Hunter Hospital, Hunter New England Local Health District and University of Newcastle, Australia; and St. George's (J.W.N.), University of London, UK.
Neurology. 2017 Feb 14;88(7):646-652. doi: 10.1212/WNL.0000000000003617. Epub 2017 Jan 13.
To determine the natural history of dissecting aneurysm (DA) and whether DA is associated with an increased recurrent stroke risk and whether type of antithrombotic drugs (antiplatelets vs anticoagulants) modifies the persistence or development of DA.
We included 264 patients with extracranial cervical artery dissection (CAD) from the Cervical Artery Dissection in Stroke Study (CADISS), a multicenter prospective study that compared antiplatelet with anticoagulation therapy. Logistic regression was used to estimate age- and sex-adjusted odds ratios. We conducted a systematic review of published studies assessing the natural history of DA and stroke risk in patients with non-surgically-treated extracranial CAD with DA.
In CADISS, DA was present in 24 of 264 patients at baseline. In 36 of 248 patients with follow-up neuroimaging at 3 months, 12 of the 24 baseline DAs persisted, and 24 new DA had developed. There was no association between treatment allocation (antiplatelets vs anticoagulants) and whether DA at baseline persisted at follow-up or whether new DA developed. During 12 months of follow-up, stroke occurred in 1 of 48 patients with DA and in 7 of 216 patients without DA (age- and sex-adjusted odds ratio 0.84; 95% confidence interval 0.10-7.31; = 0.88). Published studies, mainly retrospective, showed a similarly low risk of stroke and no evidence of an increased stroke rate in patients with DA.
The results of CADISS provide evidence suggesting that DAs may have benign prognosis and therefore medical treatment should be considered.
确定夹层动脉瘤（DA）的自然病程，DA是否与复发性卒中风险增加相关，以及抗血栓药物类型（抗血小板药物与抗凝药物）是否会改变DA的持续存在或发展。
我们纳入了来自卒中研究中的颈动脉夹层（CADISS）这一多中心前瞻性研究的264例颅外颈动脉夹层（CAD）患者，该研究比较了抗血小板治疗与抗凝治疗。采用逻辑回归来估计年龄和性别调整后的比值比。我们对已发表的评估非手术治疗的伴有DA的颅外CAD患者中DA的自然病程和卒中风险的研究进行了系统评价。
在CADISS中，264例患者基线时24例存在DA。在248例有3个月随访神经影像学检查的患者中，24例基线DA中有12例持续存在，且出现了24例新的DA。治疗分配（抗血小板药物与抗凝药物）与基线时的DA在随访时是否持续存在或是否出现新的DA之间无关联。在12个月的随访期间，48例有DA的患者中有1例发生卒中，216例无DA的患者中有7例发生卒中（年龄和性别调整后的比值比为0.84；95%置信区间为0.10 - 7.31；P = 0.88）。已发表的研究（主要为回顾性研究）显示，DA患者的卒中风险同样较低，且无证据表明卒中发生率增加。
CADISS的结果提供了证据，提示DA可能预后良好，因此应考虑药物治疗。
