年轻短暂性脑缺血发作和中风患者的动脉迂曲扩张及小血管疾病
Dolichoectasia and Small Vessel Disease in Young Patients With Transient Ischemic Attack and Stroke.
作者信息
Thijs Vincent, Grittner Ulrike, Fazekas Franz, McCabe Dominick J H, Giese Anne-Katrin, Kessler Christof, Martus Peter, Norrving Bo, Ringelstein Erich Bernd, Schmidt Reinhold, Tanislav Christian, Putaala Jukka, Tatlisumak Turgut, von Sarnowski Bettina, Rolfs Arndt, Enzinger Christian
机构信息
From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
出版信息
Stroke. 2017 Sep;48(9):2361-2367. doi: 10.1161/STROKEAHA.117.017406. Epub 2017 Jul 28.
BACKGROUND AND PURPOSE
We evaluated whether basilar dolichoectasia is associated with markers of cerebral small vessel disease in younger transient ischemic attack and ischemic stroke patients.
METHODS
We used data from the SIFAP1 study (Stroke in Young Fabry Patients), a large prospective, hospital-based, screening study for Fabry disease in young (<55 years) transient ischemic attack/stroke patients in whom detailed clinical data and brain MRI were obtained, and stroke subtyping with TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment) was performed.
RESULTS
Dolichoectasia was found in 508 of 3850 (13.2%) of patients. Dolichoectasia was associated with older age (odds ratio per decade, 1.26; 95% confidence interval, 1.09-1.44), male sex (odds ratio, 1.96; 95% confidence interval, 1.59-2.42), and hypertension (odds ratio, 1.39; 95% confidence interval, 1.13-1.70). Dolichoectasia was more common in patients with small infarctions (33.9% versus 29.8% for acute lesions, =0.065; 29.1% versus 16.5% for old lesions, <0.001), infarct location in the brain stem (12.4% versus 6.9%, <0.001), and in white matter (27.8% versus 21.1%, =0.001). Microbleeds (16.3% versus 4.7%, =0.001), higher grades of white matter hyperintensities (<0.001), and small vessel disease subtype (18.1% versus 12.4%, overall for differences in TOAST (=0.018) were more often present in patients with dolichoectasia.
CONCLUSIONS
Dolichoectasia is associated with imaging markers of small vessel disease and brain stem localization of acute and old infarcts in younger patients with transient ischemic attack and ischemic stroke.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583.
背景与目的
我们评估了在年轻的短暂性脑缺血发作和缺血性卒中患者中，基底动脉延长扩张是否与脑小血管病的标志物相关。
方法
我们使用了SIFAP1研究（年轻法布里病患者的卒中）的数据，这是一项针对年轻（<55岁）短暂性脑缺血发作/卒中患者的大型前瞻性、基于医院的法布里病筛查研究，获取了详细的临床数据和脑部MRI，并采用急性卒中治疗中ORG 10172试验（TOAST分类）进行卒中亚型分类。
结果
在3850例患者中的508例（13.2%）发现了延长扩张。延长扩张与年龄较大（每十年的优势比为1.26；95%置信区间为1.09 - 1.44）、男性（优势比为1.96；95%置信区间为1.59 - 2.42）和高血压（优势比为1.39；95%置信区间为1.13 - 1.70）相关。延长扩张在小梗死患者中更常见（急性病变为33.9%对29.8%，P = 0.065；陈旧性病变为29.1%对16.5%，P < 0.001）、梗死位于脑干（12.4%对6.9%，P < 0.001）以及白质中（27.8%对21.1%，P = 0.001）。微出血（16.3%对4.7%，P = 0.001）、更高等级的白质高信号（P < 0.001）以及小血管病亚型（18.1%对12.4%，TOAST分类差异的总体P = 0.018）在延长扩张患者中更常出现。
结论
在年轻的短暂性脑缺血发作和缺血性卒中患者中，延长扩张与小血管病的影像学标志物以及急性和陈旧性梗死的脑干定位相关。
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