Derdeyn Colin P, Zipfel Gregory J, Zazulia Allyson R, Davis Patricia H, Prabhakaran Shyam, Ivan Cristina S, Aiyagari Venkatesh, Sagar James R, Hantler Nancy, Shinawi Lina, Lee John J, Jafri Hussain, Grubb Robert L, Miller J Philip, Dacey Ralph G
From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
Stroke. 2017 Apr;48(4):894-899. doi: 10.1161/STROKEAHA.116.014538. Epub 2017 Mar 10.
The purpose was to test the hypothesis that increased oxygen extraction fraction (OEF), a marker of severe hemodynamic impairment measured by positron emission tomography, is an independent risk factor for subsequent ischemic stroke in this population.
Adults with idiopathic moyamoya phenomena were recruited between 2005 and 2012 for a prospective, multicenter, blindly adjudicated, longitudinal cohort study. Measurements of OEF were obtained on enrollment. Subjects were followed up for the occurrence of ipsilateral ischemic stroke at 6-month intervals. Patients were censored at the time of surgical revascularization or at last follow-up. The primary analysis was time to ischemic stroke in the territory of the occlusive vasculopathy.
Forty-nine subjects were followed up during a median of 3.7 years. One of 16 patients with increased OEF on enrollment had an ischemic stroke and another had an intraparenchymal hemorrhage. Three of 33 patients with normal OEF had an ischemic stroke. On a per-hemisphere basis, 21 of 79 hemispheres with moyamoya vasculopathy had increased OEF at baseline. No ischemic strokes and one hemorrhage occurred in a hemisphere with increased OEF (n=21). Sixteen patients (20 hemispheres), including 5 with increased OEF at enrollment, were censored at a mean of 5.3 months after enrollment for revascularization surgery.
The risk of new or recurrent stroke was lower than expected. The low event rate, low prevalence of increased OEF, and potential selection bias introduced by revascularization surgery limit strong conclusions about the association of increased OEF and future stroke risk.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00629915.
本研究旨在验证以下假设：通过正电子发射断层扫描测量得到的氧摄取分数（OEF）升高，作为严重血流动力学损害的一个指标，是该人群后续发生缺血性卒中的独立危险因素。
2005年至2012年间招募了患有特发性烟雾病现象的成年人，进行一项前瞻性、多中心、盲法判定的纵向队列研究。在入组时测量OEF。每6个月对受试者进行随访，观察同侧缺血性卒中的发生情况。在进行手术血运重建时或最后一次随访时对患者进行截尾。主要分析为闭塞性血管病变区域发生缺血性卒中的时间。
49名受试者接受了中位时间为3.7年的随访。入组时OEF升高的16名患者中有1名发生了缺血性卒中，另1名发生了脑实质内出血。OEF正常的33名患者中有3名发生了缺血性卒中。在每侧半球水平上，79个患有烟雾病血管病变的半球中有21个在基线时OEF升高。OEF升高的半球（n = 21）未发生缺血性卒中，仅发生了1次出血。16名患者（20个半球），包括入组时OEF升高的5名患者，在入组后平均5.3个月因血运重建手术而被截尾。
新发或复发性卒中的风险低于预期。低事件发生率、OEF升高的低患病率以及血运重建手术引入的潜在选择偏倚限制了关于OEF升高与未来卒中风险之间关联的有力结论。
