Takahashi Yoshiaki, Yamashita Toru, Morihara Ryuta, Nakano Yumiko, Sato Kota, Takemoto Mami, Hishikawa Nozomi, Ohta Yasuyuki, Manabe Yasuhiro, Abe Koji
Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan.
Department of Neurology, Okayama National Hospital Medical Center, Okayama, Japan.
J Stroke Cerebrovasc Dis. 2017 Jun;26(6):1314-1320. doi: 10.1016/j.jstrokecerebrovasdis.2017.02.001. Epub 2017 Mar 29.
Among several types of ischemic stroke (IS), branch atheromatous disease (BAD) is known to be the leading cause of disability.
A total of 1919 patients with acute IS were retrospectively analyzed, and BAD patients were classified into anterior or posterior BAD, depending on the responsible vascular territories. These patients were further subcategorized with or without early neurologic deterioration (END or no-END).
Of all IS patients, 14.3% had BAD, and 202 patients (73.7%) were further classified as anterior BAD and 72 patients (26.3%) as posterior BAD. The prevalence of diabetes mellitus and END was significantly higher in posterior than in anterior BAD (44.4% vs 26.4%, P < .01; 18.1% vs 5.4%, P < .01, respectively). Posterior BAD showed a higher proportion of female patients and an older age (69.2% vs 39.0%, P < .05; 79.1 ± 7.7 vs 70.5 ± 10.7, P < .01, respectively) in END than in no-END. The modified Rankin Scale was worse in posterior BAD at 90 days (2.5 ± 1.6, P < .01) than in anterior BAD (1.6 ± 1.4).
Our present study shows that posterior BAD is a worse clinical outcome than anterior BAD, with more vascular risk factors. Older female patients with posterior BAD showed a higher risk of END, leading to a worse clinical outcome.
在几种类型的缺血性卒中（IS）中，分支动脉粥样硬化病（BAD）是导致残疾的主要原因。
对1919例急性IS患者进行回顾性分析，根据责任血管区域将BAD患者分为前循环BAD或后循环BAD。这些患者进一步分为有或无早期神经功能恶化（END或无END）。
在所有IS患者中，14.3%患有BAD，其中202例（73.7%）进一步分类为前循环BAD，72例（26.3%）为后循环BAD。后循环BAD患者的糖尿病患病率和END发生率显著高于前循环BAD（分别为44.4%对26.4%，P < .01；18.1%对5.4%，P < .01）。与无END的患者相比，后循环BAD且发生END的患者中女性比例更高，年龄更大（分别为69.2%对39.0%，P < .05；79.1 ± 7.7对70.5 ± 10.7，P < .01）。90天时，后循环BAD患者的改良Rankin量表评分比前循环BAD患者更差（2.5 ± 1.6，P < .01）（前循环BAD为1.6 ± 1.4）。
我们目前的研究表明，后循环BAD的临床结局比前循环BAD更差，血管危险因素更多。后循环BAD的老年女性患者发生END的风险更高，导致临床结局更差。
