急性缺血性脑卒中伴可见动脉闭塞的发生率：一项基于人群的研究（第戎卒中登记研究）。

Incidence of Acute Ischemic Stroke With Visible Arterial Occlusion: A Population-Based Study (Dijon Stroke Registry).

机构信息

Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France.

出版信息

Stroke. 2020 Jul;51(7):2122-2130. doi: 10.1161/STROKEAHA.120.029949. Epub 2020 Jun 3.

DOI:10.1161/STROKEAHA.120.029949

PMID:32486967

Abstract

BACKGROUND AND PURPOSE

Because of several methodological limitations, previous studies focusing on the prevalence of large vessel occlusion in ischemic stroke (IS) patients provided conflicting results. We evaluated the incidence of IS with a visible arterial occlusion using a comprehensive population-based registry.

METHODS

Patients with acute IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013-2017). All arterial imaging exams were reviewed to assess arterial occlusion. Annual incidence rates of IS (first-ever and recurrent events) and IS with a visible occlusion were calculated.

RESULTS

One thousand sixty cases of IS were recorded (mean age: 76.0±15.8 years, 53.9% women). Information about arterial imaging was available in 971 (91.6%) of them, and only preexisting dementia was independently associated with having missing information (odds ratio=0.34 [95% CI, 0.18-0.65], =0.001). Among these patients, 284 (29.2%) had a visible arterial occlusion. Occlusion site was the anterior circulation in 226 patients (23.3% of overall patients with available data) and the posterior circulation in 58 patients (6.0%). A proximal occlusion of the anterior circulation was observed in 167 patients (17.2%). The crude annual incidence rate of total IS per 100 000 was 138 (95% CI, 129-146). Corresponding standardized rates were 66 (95% CI, 50-82) to the World Health Organization and 141 (95% CI, 118-164) to the 2013 European populations. The crude annual incidence rate of IS with a visible arterial occlusion per 100 000 was 37 (95% CI, 33-41) and that of IS with a proximal occlusion of the anterior circulation was 22 (95% CI, 18-25). Corresponding standardized rates were 18 (95% CI, 10-26) and 10 (95% CI, 8-13) to the World Health Organization population, and 38 (95% CI, 26-50) and 23 (95% CI, 19-26) to the 2013 European population, respectively.

CONCLUSIONS

These results will be helpful to plan the need for thrombectomy-capable stroke center resources.

摘要

背景与目的

由于存在若干方法学限制，既往聚焦于缺血性卒中（IS）患者大血管闭塞发生率的研究结果存在差异。我们通过一项基于人群的注册研究，评估了使用综合人群登记系统发现的 IS 患者动脉闭塞的发生率。

方法

采用基于人群的登记系统（2013-2017 年）前瞻性识别法国第戎市的急性 IS 患者。所有动脉影像学检查均进行了评估，以确定是否存在动脉闭塞。计算首次发生和复发事件的 IS 以及可见动脉闭塞的年度发生率。

结果

共记录了 1060 例 IS（平均年龄：76.0±15.8 岁，53.9%为女性）。971 例患者（91.6%）的动脉影像学信息可用，仅预先存在痴呆与信息缺失独立相关（比值比=0.34[95%CI，0.18-0.65]，=0.001）。在这些患者中，284 例（29.2%）存在可见的动脉闭塞。前循环闭塞 226 例（总体可获取数据患者中占 23.3%），后循环闭塞 58 例（6.0%）。前循环近端闭塞 167 例（17.2%）。每 100000 人年总 IS 的粗发生率为 138（95%CI，129-146）。相应的标准化发生率为世界卫生组织标准 66（95%CI，50-82），2013 年欧洲人群标准 141（95%CI，118-164）。每 100000 人年可见动脉闭塞性 IS 的粗发生率为 37（95%CI，33-41），前循环近端闭塞性 IS 的发生率为 22（95%CI，18-25）。相应的标准化发生率为世界卫生组织人群标准 18（95%CI，10-26）和 2013 年欧洲人群标准 10（95%CI，8-13），为 38（95%CI，26-50）和 23（95%CI，19-26）。