Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
J Neurol. 2020 Jun;267(6):1687-1698. doi: 10.1007/s00415-020-09750-2. Epub 2020 Feb 25.
Intracranial stenoses can cause TIA/ischaemic stroke. The purpose of this study was to assess vascular risk factors, clinical and imaging findings and outcome in Caucasians with intracranial stenosis under best prevention management.
In this prospective observational study (from 05/2012, to last follow-up 06/2017) we compared vascular risk factors, imaging findings and long-term outcome in Swiss patients with symptomatic versus asymptomatic intracranial atherosclerotic stenoses on best prevention management.
62 patients were included [35.5% women, median age 68.3 years], 33 (53.2%) with symptomatic intracranial stenoses. Vascular risk factors (p = 0.635) and frequency of anterior circulation stenoses (66.7% vs. 55.2%; p = 0.354) did not differ between symptomatic and asymptomatic patients, but CT/MR-perfusion deficits in the territory of the stenosis (81.8% vs. 51.7%; p = 0.011) were more common in symptomatic patients. Outcome in symptomatic and asymptomatic patients at last follow-up was similar (mRS 0-1:66.7% vs. 75%;p = 0.937, mRS p-shift = 0.354, survival:100% vs. 96.4%;p = 0.979). However, during 59,417 patient follow-up days, symptomatic patients experienced more cerebrovascular events (ischaemic stroke or TIA) [37.5% vs. 7.1%;HR 7.58;p = 0.012], mainly in the territory of the stenosis [31.3% vs. 3.6%;HR 12.69;p = 0.019], more vascular events (i.e. ischaemic stroke/TIA/TNA and acute coronary/peripheral vascular events) [62.5% vs. 14.3%;HR 6.37;p = 0.001]) and more multiple vascular events (p-trend = 0.006; ≥ 2:37.5% vs. 10.7%; OR 5.37;p = 0.022) than asymptomatic patients.
Despite best prevention management, one in three patients with a symptomatic intracranial stenosis suffered a cerebrovascular event, three in five a vascular event and two in five ≥ 2 vascular events. There is an unmet need for more rigorous and effective preventive strategies in patients with symptomatic intracranial stenoses.
颅内狭窄可导致 TIA/缺血性中风。本研究旨在评估在最佳预防管理下，白种人群颅内狭窄患者的血管危险因素、临床和影像学表现及预后。
在这项前瞻性观察研究（2012 年 5 月至 2017 年 6 月最后一次随访）中，我们比较了瑞士患者在最佳预防管理下有症状和无症状颅内动脉粥样硬化性狭窄的血管危险因素、影像学表现和长期预后。
共纳入 62 例患者[35.5%为女性，中位年龄 68.3 岁]，33 例（53.2%）为有症状颅内狭窄。有症状和无症状患者的血管危险因素（p=0.635）和前循环狭窄的频率（66.7%与 55.2%；p=0.354）无差异，但狭窄区域的 CT/MR 灌注缺损（81.8%与 51.7%；p=0.011）在有症状患者中更常见。有症状和无症状患者在最后一次随访时的预后相似（mRS 0-1：66.7%与 75%；p=0.937，mRS 差值 p=0.354，生存率：100%与 96.4%；p=0.979）。然而，在 59417 患者随访日中，有症状患者发生更多的脑血管事件（缺血性中风或 TIA）[37.5%与 7.1%；HR 7.58；p=0.012]，主要发生在狭窄区域[31.3%与 3.6%；HR 12.69；p=0.019]，更多血管事件（即缺血性中风/TIA/TNA 和急性冠状动脉/外周血管事件）[62.5%与 14.3%；HR 6.37；p=0.001]和更多多次血管事件（p 趋势=0.006；≥2 次：37.5%与 10.7%；OR 5.37；p=0.022）比无症状患者更常见。
尽管进行了最佳预防管理，仍有三分之一的有症状颅内狭窄患者发生脑血管事件，五分之三的患者发生血管事件，五分之二的患者发生≥2 次血管事件。有症状颅内狭窄患者需要更严格和有效的预防策略。
