颅外血管解剖术后再通：抗血小板治疗与抗凝治疗的效果比较
Recanalization after Extracranial Dissection: Effect of Antiplatelet Compared with Anticoagulant Therapy.
作者信息
Ramchand Preethi, Mullen Michael T, Bress Aaron, Hurst Robert, Kasner Scott E, Cucchiara Brett L, Messé Steven R
机构信息
Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
J Stroke Cerebrovasc Dis. 2018 Feb;27(2):438-444. doi: 10.1016/j.jstrokecerebrovasdis.2017.09.065. Epub 2017 Oct 31.
BACKGROUND
Cervical arterial dissection is a leading cause of stroke in young patients, yet optimal management remains controversial. Existing studies focusing on recurrent stroke were underpowered to demonstrate differences between antithrombotic strategies. Vessel recanalization is a more prevalent outcome and is potentially clinically important. We aimed to assess recanalization rates with anticoagulation compared with antiplatelet therapy.
METHODS
We studied a single-center retrospective cohort of patients with extracranial carotid or vertebral artery dissection. Subjects with baseline and follow-up imaging between 1999 and 2013 were included. Stenosis was measured using North American Symptomatic Carotid Endarterectomy Trial methodology. Univariate and multivariable analyses were performed to determine factors associated with recanalization, defined as ≥50% relative improvement in stenosis from baseline to follow-up imaging. Secondary analyses assessed absolute and relative stenosis change and limited the cohort to >50% stenosis at diagnosis.
RESULTS
We identified 75 patients with 84 dissections, mean age 47 years, 43% female, 39% non-white. Patients treated with anticoagulation had worse stenosis at baseline (median 99% versus 50%, P = .02). Comparing anticoagulation with antiplatelet therapy in the first month, there were no differences in the rates of ≥50% relative improvement in stenosis (50% versus 48%, P = .84) nor in absolute (median 16% versus 7%, P = .34) or relative (median 48% versus 43%, P = .92) change in stenosis from baseline to follow-up. In multivariable analysis, anticoagulation was not associated with recanalization (odds ratio [OR] 1.41, 95% confidence interval [CI]: .5-4.1, P = .52), whereas hypertension was negatively associated (OR .26, 95% CI: .09-.72, P = .009).
CONCLUSIONS
Anticoagulation was not associated with greater likelihood of recanalization compared with antiplatelet medication therapy.
背景
颈动脉硬化夹层是年轻患者中风的主要原因，但最佳治疗方案仍存在争议。现有针对复发性中风的研究在证明抗血栓策略之间的差异方面能力不足。血管再通是一种更常见的结果，且可能具有临床重要性。我们旨在评估抗凝治疗与抗血小板治疗相比的再通率。
方法
我们研究了一个单中心回顾性队列，该队列包含颅外颈动脉或椎动脉夹层患者。纳入了1999年至2013年间有基线和随访影像学检查的受试者。使用北美症状性颈动脉内膜切除术试验方法测量狭窄程度。进行单变量和多变量分析以确定与再通相关的因素，再通定义为从基线到随访影像学检查狭窄相对改善≥50%。二次分析评估绝对和相对狭窄变化，并将队列限制为诊断时狭窄>50%的患者。
结果
我们确定了75例患者，共84处夹层，平均年龄47岁，43%为女性，39%为非白人。接受抗凝治疗的患者基线时狭窄情况更严重（中位数99%对50%，P = 0.02）。在第一个月将抗凝治疗与抗血小板治疗进行比较，狭窄相对改善≥50%的发生率没有差异（50%对48%，P = 0.84），从基线到随访的狭窄绝对变化（中位数16%对7%，P = 0.34）或相对变化（中位数48%对43%，P = 0.92）也没有差异。在多变量分析中，抗凝治疗与再通无关（优势比[OR]1.41，95%置信区间[CI]：0.5 - 4.1，P = 0.52），而高血压与之呈负相关（OR 0.26，95% CI：0.09 - 0.72，P = 0.009）。
结论
与抗血小板药物治疗相比，抗凝治疗与更高的再通可能性无关。
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