Department of Neurosurgery (S.A.-H., A.P.S., X.D., L.R.-F., F.T.C.), University of Illinois at Chicago.
Department of Neurology and Rehabilitation (D.K.P.), University of Illinois at Chicago.
Stroke. 2020 Nov;51(11):3295-3301. doi: 10.1161/STROKEAHA.120.029909. Epub 2020 Oct 9.
The role of regional hypoperfusion as a contributor to stroke risk in atherosclerotic vertebrobasilar disease has recently been confirmed by the observational VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) Study. We examined the stability of hemodynamic status over time and its relationship to stroke risk in patients from this prospective cohort.
VERiTAS enrolled patients with recently symptomatic ≥50% atherosclerotic stenosis/occlusion of vertebral and/or basilar arteries. Large vessel flow in the vertebrobasilar territory was assessed using quantitative magnetic resonance angiography, and patients were designated as low or normal flow based on distal territory regional flow, incorporating collateral capacity. Patients underwent standard medical management and follow-up for primary outcome event of vertebrobasilar territory stroke. Quantitative magnetic resonance angiography imaging was repeated at 6, 12, and 24 months. Flow status over time was examined relative to baseline and relative to subsequent stroke risk using a cause-specific proportional hazard model, with flow status treated as a time-varying covariate. Mean blood pressure was examined to assess for association with changes in flow status.
Over 19±8 months of follow-up, 132 follow-up quantitative magnetic resonance angiography studies were performed in 58 of the 72 enrolled patients. Of the 13 patients with serial imaging who had low flow at baseline, 7 (54%) had improvement to normal flow at the last follow-up. Of the 45 patients who had normal flow at baseline, 3 (7%) converted to low flow at the last follow-up. The mean blood pressure did not differ in patients with or without changes in flow status. The time-varying flow status remained a strong predictor of subsequent stroke (hazard ratio, 10.3 [95% CI, 2.2-48.7]).
There is potential both for improvement and worsening of hemodynamics in patients with atherosclerotic vertebrobasilar disease. Flow status, both at baseline and over time, is a risk factor for subsequent stroke, thus serving as an important prognostic marker. Registration: URL: https://clinicaltrials.gov. Unique identifier: NCT00590980.
最近通过观察性 VERiTAS（椎动脉血流评估及短暂性脑缺血发作和卒中风险）研究证实，区域性低灌注在粥样硬化性椎基底动脉疾病导致的卒中风险中发挥作用。我们通过这项前瞻性队列研究，考察了患者的血流动力学状态随时间的稳定性及其与卒中风险的关系。
VERiTAS 纳入了椎动脉和/或基底动脉存在近期有症状的≥50%粥样硬化性狭窄/闭塞的患者。通过定量磁共振血管造影评估椎基底动脉区域的大血管血流，根据远端区域血流（包含侧支循环能力）将患者分为低灌注或正常灌注。患者接受标准的医疗管理和随访，以评估椎基底动脉区域卒中的主要结局事件。在 6、12 和 24 个月时重复定量磁共振血管造影成像。使用基于事件的比例风险模型，根据基线和随后的卒中风险考察随时间变化的血流状态，将血流状态视为时变协变量。考察平均血压与血流状态变化之间的关联。
在 19±8 个月的随访期间，72 例入组患者中的 58 例完成了 132 次随访定量磁共振血管造影研究。在基线时为低灌注的 13 例患者中，有 7 例（54%）在最后一次随访时改善为正常灌注。在基线时为正常灌注的 45 例患者中，有 3 例（7%）在最后一次随访时转为低灌注。有或无血流状态变化的患者之间平均血压无差异。时变血流状态仍然是随后卒中的强烈预测因素（风险比，10.3[95%CI，2.2-48.7]）。
在患有粥样硬化性椎基底动脉疾病的患者中，血流动力学可能会改善，也可能会恶化。血流状态，无论是在基线还是随时间变化，都是随后卒中的危险因素，因此是一个重要的预后标志物。登记信息：网址：https://clinicaltrials.gov。唯一标识符：NCT00590980。
