多发性和早发性颈内动脉夹层的决定因素和结局。
Determinants and outcome of multiple and early recurrent cervical artery dissections.
机构信息
From the Department of Neuro-oncology (A.C.), Netherlands Cancer Institute/Antoni van Leeuwenhoek; Department of Neurology (A.C.), MC Slotervaart, Amsterdam, the Netherlands; University of Bordeaux (S.S., S.D.); Bordeaux Population Health (S.S., S.D.), INSERM Center U1219, France; Department of Neurology (C.J.V., B.G.-S., H.S., S.J., U.F., M.A.), University Hospital Inselspital and University of Bern; Division of Neuropediatrics (B.G.-S.), San Giovanni Hospital Bellinzona, Switzerland; Department of Neurology (T.M.M., T.T.), Helsinki University Central Hospital, Finland; Departments of Neurology and Public Health Sciences (A.S., B.B.W.), University of Virginia, Charlottesville; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Italy; Department of Neurology (M.K., C.G.-G., C.L.), Heidelberg University Hospital, Germany; Normandie Université (E.T.), Unicaen, CHU Caen, Inserm U1237; Université Paris Descartes (E.T.), CH Ste Anne, Inserm U894, Paris, France; Stroke Division (V.T.), Florey Institute for Neuroscience and Mental Health, University of Melbourne; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (Y.B.), Dijon University Hospital; Department of Neurology (P.R., H.C., M.-G.B.), Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, France; Cerebrovascular Unit (A.B.), IRCCS Foundation C. Besta Neurological Institute, Milan, Italy; Suva/Swiss National Accident Insurance Fund (T.B.), Lucerne, Switzerland; Stroke Unit and Division of Internal and Cardiovascular Medicine (V.C.), University of Perugia, Italy; Department of Neurology and Stroke Center (P.A.L., C.T., S.T.E.), Department of Clinical Research, University Hospital and University of Basel, Switzerland; Neurology Clinic (C.L.), Memmingen Hospital, Germany; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Department of Neurology (D.L.), Lille University, INSERM U1171, France; NeuroCentre (R.W.B.), Clinic Hirslanden Zürich, Switzerland; Neurorehabilitation Unit (S.T.E.), University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, University of Basel, Switzerland; INSERM 1176 (J.D.), Institut Pasteur de Lille, France; Department of Clinical Neuroscience (T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden; and Department of Neurology-Memory Clinic (S.D.), Bordeaux University Hospital, France.
出版信息
Neurology. 2018 Aug 21;91(8):e769-e780. doi: 10.1212/WNL.0000000000006037. Epub 2018 Aug 1.
OBJECTIVE
To assess putative risk factors and outcome of multiple and early recurrent cervical artery dissection (CeAD).
METHODS
We combined data from 2 multicenter cohorts and compared patients with multiple CeAD at initial diagnosis, early recurrent CeAD within 3 to 6 months, and single nonrecurrent CeAD. Putative risk factors, clinical characteristics, functional outcome, and risk of recurrent ischemic events were assessed.
RESULTS
Of 1,958 patients with CeAD (mean ± SD age 44.3 ± 10 years, 43.9% women), 1,588 (81.1%) had single nonrecurrent CeAD, 340 (17.4%) had multiple CeAD, and 30 (1.5%) presented with single CeAD at admission and had early recurrent CeAD. Patients with multiple or early recurrent CeAD did not significantly differ with respect to putative risk factors, clinical presentation, and outcome. In multivariable analyses, patients with multiple or early recurrent CeAD more often had recent infection (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.29-2.53), vertebral artery dissection (OR 1.82, 95% CI 1.34-2.46), family history of stroke (OR 1.55, 95% CI 1.06-2.25), cervical pain (OR 1.36, 95% CI 1.01-1.84), and subarachnoid hemorrhage (OR 2.85, 95% CI 1.01-8.04) at initial presentation compared to patients with single nonrecurrent CeAD. Patients with multiple or early recurrent CeAD also had a higher incidence of cerebral ischemia (hazard ratio 2.77, 95% CI 1.49-5.14) at 3 to 6 months but no difference in functional outcome compared to patients with single nonrecurrent CeAD.
CONCLUSION
Patients with multiple and early recurrent CeAD share similar risk factors, clinical characteristics, and functional outcome. Compared to patients with single nonrecurrent CeAD, they are more likely to have recurrent cerebral ischemia at 3 to 6 months, possibly reflecting an underlying transient vasculopathy.
目的
评估多发性和早期复发性颈内动脉夹层（CeAD）的潜在危险因素和结局。
方法
我们结合了 2 个多中心队列的数据，并比较了初始诊断时多发性 CeAD、3 至 6 个月内早期复发性 CeAD 和单发非复发性 CeAD 的患者。评估了潜在的危险因素、临床特征、功能结局和复发性缺血事件的风险。
结果
在 1958 例 CeAD 患者（平均年龄 44.3 ± 10 岁，43.9%为女性）中，1588 例（81.1%）为单发非复发性 CeAD，340 例（17.4%）为多发性 CeAD，30 例（1.5%）入院时为单发 CeAD，且早期复发性 CeAD。多发性或早期复发性 CeAD 的患者在潜在危险因素、临床表现和结局方面无显著差异。多变量分析显示，多发性或早期复发性 CeAD 的患者近期感染（优势比 [OR] 1.81，95%置信区间 [CI] 1.29-2.53）、椎动脉夹层（OR 1.82，95%CI 1.34-2.46）、家族性卒中史（OR 1.55，95%CI 1.06-2.25）、颈痛（OR 1.36，95%CI 1.01-1.84）和蛛网膜下腔出血（OR 2.85，95%CI 1.01-8.04）更为常见。与单发非复发性 CeAD 患者相比，多发性或早期复发性 CeAD 的患者在 3 至 6 个月时发生脑缺血的发生率更高（危险比 2.77，95%CI 1.49-5.14），但与单发非复发性 CeAD 的患者相比，其功能结局无差异。
结论
多发性和早期复发性 CeAD 的患者具有相似的危险因素、临床特征和功能结局。与单发非复发性 CeAD 的患者相比，他们在 3 至 6 个月时更有可能发生复发性脑缺血，这可能反映了潜在的短暂血管病变。
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