巴塞罗那无症状颅内动脉粥样硬化研究：亚临床颅内动脉粥样硬化作为长期血管事件的预测指标。

The Barcelona-Asymptomatic Intracranial Atherosclerosis study: Subclinical intracranial atherosclerosis as predictor of long-term vascular events.

机构信息

Departamento de Neurociencias, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain.

Atención Primaria, ABS Nord-Riu Sud, Santa Coloma de Gramenet, Barcelona, Spain; Unitat de Suport a La Recerca (USR) Metropolitana Nord, IDIAP-J Gol, Mataró, Spain.

出版信息

Atherosclerosis. 2019 Mar;282:132-136. doi: 10.1016/j.atherosclerosis.2019.01.022. Epub 2019 Jan 29.

DOI:10.1016/j.atherosclerosis.2019.01.022

PMID:30731285

Abstract

BACKGROUND AND AIMS

Symptomatic intracranial atherosclerosis (ICAS) is associated with a high risk of stroke recurrence and occurrence of other vascular events. However, ICAS has been poorly studied from its asymptomatic stage. The objective of our study was to determine if subclinical intracranial atherosclerosis is associated with long-term incident vascular events in Caucasians.

METHODS

The Barcelona-Asymptomatic Intracranial Atherosclerosis (AsIA) Study is a population-based study that enrolled 933 subjects with a moderate-high vascular risk and without history of stroke or coronary disease, and determined the prevalence of asymptomatic ICAS and associated risk factors. At baseline visit, carotid atherosclerosis and ICAS were screened by color-coded duplex ultrasound, and moderate-severe stenosis was confirmed by magnetic resonance angiography. At baseline, 8.9% of subjects had asymptomatic ICAS, of whom 3.3% were moderate-severe. In the longitudinal phase, subjects were prospectively followed-up to assess the incidence of a combined primary endpoint of vascular events (stroke, acute coronary syndrome and/or vascular death).

RESULTS

After 7.17 years of follow-up, there were 51 incident cerebrovascular events (16 transient ischemic attacks, 27 ischemic, 8 hemorrhagic strokes), 63 incident coronary events and 23 vascular deaths. After multivariate Cox regression analyses adjusted by age, sex, vascular risk and presence of carotid plaques, ICAS was an independent predictor for overall vascular events (HR 1.83 [1.10-3.03], p = 0.020), and moderate-severe intracranial stenosis was also an independent predictor for cerebrovascular events (HR 2.66 [1.02-6.94], p = 0.046).

CONCLUSIONS

Asymptomatic ICAS is independently associated with the incidence of future vascular events in our population. These findings might have implications for the development of primary prevention strategies.

摘要

背景与目的

有症状颅内动脉粥样硬化（ICAS）与卒中复发和其他血管事件的发生风险较高相关。然而，ICAS 在无症状阶段研究甚少。本研究旨在确定亚临床颅内动脉粥样硬化是否与白种人群的长期血管事件有关。

方法

巴塞罗那无症状颅内动脉粥样硬化（AsIA）研究是一项基于人群的研究，纳入了 933 名中高危血管风险且无卒中或冠心病病史的患者，评估无症状 ICAS 的患病率及相关危险因素。基线时，采用彩色双功能超声筛查颈动脉粥样硬化和 ICAS，并采用磁共振血管造影术确认中重度狭窄。基线时，8.9%的患者有亚临床 ICAS，其中 3.3%为中重度狭窄。在纵向阶段，前瞻性随访患者以评估血管事件（卒、急性冠状动脉综合征和/或血管性死亡）的复合首发终点的发生率。

结果

随访 7.17 年后，共发生 51 例脑血管事件（16 例短暂性脑缺血发作，27 例缺血性卒，8 例出血性卒）、63 例冠状动脉事件和 23 例血管性死亡。经多变量 Cox 回归分析校正年龄、性别、血管风险和颈动脉斑块后，ICAS 是总体血管事件的独立预测因子（HR 1.83 [1.10-3.03]，p=0.020），中重度颅内狭窄也是脑血管事件的独立预测因子（HR 2.66 [1.02-6.94]，p=0.046）。