Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee.
Pediatr Neurol. 2021 Jan;114:29-34. doi: 10.1016/j.pediatrneurol.2020.10.006. Epub 2020 Oct 22.
Prevalence and contribution of intracranial and extracranial arterial stenosis to stroke risk were assessed prospectively in children and young adults with sickle cell disease.
In this cross-sectional study, children and young adults (mean = 19.4 years) with sickle cell disease underwent neurological examination, brain MRI, and magnetic resonance angiography of the head and neck. Two neuroradiologists independently recorded infarcts and arterial stenosis. Clinical features and stroke outcomes were compared between participants with and without stenosis and between children and young adults. Logistic regression analysis assessed the association of variables of interest with overt stroke and silent cerebral infarct.
Of 167 participants (79 children and 88 young adults), 20 (12.0%) had intracranial stenosis, all in the anterior circulation, and nine had concurrent extracranial stenosis. No participants had isolated extracranial stenosis. Participants with intracranial stenosis were more likely than those without stenosis to have an overt stroke (70% vs 5%, P < 0.001) or silent cerebral infarct (95% vs 35%, P < 0.001). Logistic regression analysis indicated that intracranial stenosis was strongly associated with overt stroke when compared with participants with silent cerebral infarct alone and strongly associated with silent cerebral infarct when compared with participants with normal brain MRI; male sex and age were also significant predictors of silent cerebral infarct.
Intracranial stenosis was strongly associated with both overt stroke and silent cerebral infarct; prevalence of intracranial stenosis was similar to prior estimates in sickle cell disease. Extracranial stenosis without concurrent intracranial stenosis did not occur and thus could not be evaluated as an independent risk factor for stroke.
前瞻性评估了镰状细胞病患儿和青年患者颅内和颅外动脉狭窄对卒中风险的影响及贡献。
在这项横断面研究中，镰状细胞病患儿和青年（平均年龄 19.4 岁）接受了神经系统检查、脑部 MRI 和头颈部磁共振血管造影。两位神经放射学家独立记录了梗死和动脉狭窄。比较了有和无狭窄患者以及儿童和青年患者的临床特征和卒中结局。Logistic 回归分析评估了感兴趣的变量与显性卒中和无症状性脑梗死的相关性。
在 167 名参与者（79 名儿童和 88 名青年）中，20 名（12.0%）存在颅内狭窄，均在前循环，9 名存在同时性颅外狭窄。没有参与者存在孤立性颅外狭窄。与无狭窄患者相比，颅内狭窄患者更有可能发生显性卒中和无症状性脑梗死（70%比 5%，P < 0.001）。Logistic 回归分析表明，与仅存在无症状性脑梗死的患者相比，颅内狭窄与显性卒中的相关性更强，与脑 MRI 正常的患者相比，颅内狭窄与无症状性脑梗死的相关性更强；男性和年龄也是无症状性脑梗死的显著预测因素。
颅内狭窄与显性卒中和无症状性脑梗死均有密切关系；颅内狭窄的患病率与镰状细胞病中的既往估计值相似。没有同时存在的颅外狭窄，因此不能作为卒中的独立危险因素进行评估。
