Department of Neurology, The University of Chicago, IL (S.P.).
Department of Neurology, University of California at Los Angeles (D.S.L.).
Stroke. 2021 Jun;52(6):1961-1966. doi: 10.1161/STROKEAHA.120.032676. Epub 2021 Apr 19.
While prior studies identified risk factors for recurrent stroke in patients with symptomatic intracranial atherosclerotic disease, few have assessed risk factors for early infarct recurrence.
We performed a post hoc analysis of the MYRIAD study (Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease) of intracranial atherosclerotic disease patients with recent (<21 days) stroke/transient ischemic attack, 50% to 99% stenosis and who underwent 6- to 8-week magnetic resonance imaging (MRI) per protocol. Infarct recurrence was defined as new infarcts in the territory of the symptomatic artery on brain MRI at 6 to 8 weeks compared to index brain MRI. Qualifying events and clinical and imaging outcomes were centrally ascertained by 2 independent reviewers. We assessed the association between baseline clinical and imaging variables and recurrent infarct in bivariate models and multivariable logistic regression to identify independent predictors of infarct recurrence.
Of 105 enrolled patients in MYRIAD, 89 (84.8%) were included in this analysis (mean age, 64±12 years, 54 [60.7%] were male, and 53 [59.6%] were White). The median time from qualifying event to MRI was 51+16 days, on which 22 (24.7%) patients had new or recurrent infarcts. Younger age (57.7 versus 66.0 years; <0.01), diabetes (32.6% versus 14.6%, =0.05), index stroke (31.3% versus 4.6%, =0.01), anterior circulation location of stenosis (29.7% versus 12.0%, =0.08), number of diffusion-weighted imaging lesions (>1: 40.0%, 1: 26.9% versus 0: 4.4%, <0.01), and borderzone infarct pattern (63.6% versus 25.0%, =0.01) on baseline MRI were associated with new or recurrent infarcts. Age (adjusted odds ratio, 0.93 [95% CI, 0.89-0.98], <0.01) and number of diffusion-weighted imaging lesions (adjusted odds ratio, 3.24 [95% CI, 1.36-7.71], <0.01) were independently associated with recurrent infarct adjusting for hypertension, diabetes, and stenosis location (anterior versus posterior circulation).
An index multi-infarct pattern is associated with early recurrent infarcts, a finding that might be explained by plaque instability and artery-to-artery embolism. Further investigation of plaque vulnerability in intracranial atherosclerotic disease is needed. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02121028.
尽管先前的研究已经确定了有症状颅内动脉粥样硬化性疾病患者复发性卒中的风险因素，但很少有研究评估早期梗死复发的风险因素。
我们对颅内动脉粥样硬化性疾病患者进行了 MYRIAD 研究（颅内动脉粥样硬化性疾病中的早期再发机制）的事后分析，这些患者近期（<21 天）发生了卒中/短暂性脑缺血发作，狭窄程度为 50%至 99%，并按照方案在 6 至 8 周内进行了磁共振成像（MRI）检查。梗死复发定义为在 6 至 8 周时与指数脑 MRI 相比，症状性动脉供血区的新梗死。合格事件和临床及影像学结果由 2 位独立的审查员进行中心评估。我们在双变量模型和多变量逻辑回归中评估了基线临床和影像学变量与复发性梗死之间的关系，以确定梗死复发的独立预测因素。
在 MYRIAD 中纳入的 105 例患者中，有 89 例（84.8%）被纳入本分析（平均年龄 64±12 岁，54 例[60.7%]为男性，53 例[59.6%]为白人）。从合格事件到 MRI 的中位时间为 51+16 天，其中 22 例（24.7%）患者出现新发或复发性梗死。年龄较小（57.7 岁与 66.0 岁；<0.01）、糖尿病（32.6%与 14.6%；=0.05）、指数性卒中（31.3%与 4.6%；=0.01）、狭窄部位在前循环（29.7%与 12.0%；=0.08）、弥散加权成像上的病灶数（>1 个：40.0%，1 个：26.9%，0 个：4.4%；<0.01）和边界区梗死模式（63.6%与 25.0%；=0.01）与新发或复发性梗死相关。年龄（调整后的优势比，0.93[95%置信区间，0.89-0.98]；<0.01）和弥散加权成像上的病灶数（调整后的优势比，3.24[95%置信区间，1.36-7.71]；<0.01）是与复发性梗死独立相关的因素，这些因素是通过调整高血压、糖尿病和狭窄部位（前循环与后循环）来确定的。
指数性多梗死模式与早期复发性梗死有关，这一发现可能是由于斑块不稳定和动脉到动脉栓塞所致。需要进一步研究颅内动脉粥样硬化性疾病中的斑块易损性。
