Clinical Research Center for Medicine, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo, Japan.
National Cerebral and Cardiovascular Center, Osaka, Japan.
Int J Stroke. 2019 Dec;14(9):915-922. doi: 10.1177/1747493019852177. Epub 2019 May 27.
Branch atheromatous disease (BAD) is distinctive from large and small arterial diseases, which is single subcortical infarction larger than lacunar stroke in the territories of deep perforators without relevant arterial stenosis. BAD meets the current criteria of embolic stroke of undetermined source. We performed an exploratory analysis of BAD in patients recruited to NAVIGATE embolic stroke of undetermined source, a randomized controlled trial to compare rivaroxaban and aspirin in embolic stroke of undetermined source patients.
Among 3972 stroke patients in cerebral hemispheres with intracranial arterial imaging, 502 (12.6%) patients met the criteria for BAD. BAD was associated with younger age (years; OR: 0.97, 95% CI: 0.96-0.98), race (Asian; OR: 1.78, 95% CI: 1.44-2.21), region (Eastern Europe; OR: 2.49, 95% CI: 1.87-3.32), and higher National Institute of Health Stroke Scale (OR: 1.17, 95% CI: 1.12-1.22) at randomization. During follow-up, stroke or systemic embolism (2.5%/year vs. 6.2%/year, = 0.0022), stroke (2.1%/year vs. 6.2%/year, = 0.0008), and ischemic stroke (2.1%/year vs. 5.9%/year, = 0.0013) occurred less frequently in BAD than non-BAD patients. There were no differences in annual rates of stroke or systemic embolism (2.5%/year vs. 2.5%/year, HR: 1.01, 95% CI: 0.33-3.14) or major bleeding (1.3%/year vs. 0.8%/year, HR: 1.51, 95% CI: 0.25-9.05) between rivaroxaban and aspirin groups among BAD patients.
BAD was relatively common, especially in Asian and from Eastern Europe among embolic stroke of undetermined source patients. Stroke severity was higher at randomization but recurrence of stroke was fewer in BAD than non-BAD patients. The efficacy and safety of rivaroxaban and aspirin did not differ among BAD patients.
分支粥样硬化性疾病（BAD）与大、小动脉疾病不同，其特点为深穿支动脉供血区单发皮质下梗死，梗死体积大于腔隙性脑梗死，且无相关动脉狭窄。BAD 符合不明来源栓塞性卒中的当前标准。我们对 NAVIGATE 不明来源栓塞性卒中随机对照试验中入组的脑半球卒中患者进行了 BAD 的探索性分析，该试验旨在比较利伐沙班和阿司匹林治疗不明来源栓塞性卒中患者的疗效。
在颅内动脉影像学检查的 3972 例脑卒中患者中，502 例（12.6%）患者符合 BAD 标准。BAD 与较年轻的年龄（年；OR：0.97，95%CI：0.96-0.98）、种族（亚洲人；OR：1.78，95%CI：1.44-2.21）、地域（东欧；OR：2.49，95%CI：1.87-3.32）和更高的国立卫生研究院卒中量表评分（OR：1.17，95%CI：1.12-1.22）相关。在随访期间，BAD 患者的卒中和全身性栓塞（2.5%/年 vs. 6.2%/年， = 0.0022）、卒中和（2.1%/年 vs. 6.2%/年， = 0.0008）和缺血性卒中和（2.1%/年 vs. 5.9%/年， = 0.0013）的发生率低于非 BAD 患者。BAD 患者中，利伐沙班和阿司匹林组之间的卒中或全身性栓塞的年发生率（2.5%/年 vs. 2.5%/年，HR：1.01，95%CI：0.33-3.14）或大出血（1.3%/年 vs. 0.8%/年，HR：1.51，95%CI：0.25-9.05）无差异。
BAD 在不明来源栓塞性卒中患者中较为常见，尤其是亚洲人和东欧人。BAD 患者随机分组时的卒中严重程度较高，但复发率低于非 BAD 患者。利伐沙班和阿司匹林在 BAD 患者中的疗效和安全性无差异。
