Department of Neurology, Xuanwu Hospital, Capital Medical University.
National Clinical Research Center for Geriatric Disorders.
J Atheroscler Thromb. 2022 Oct 1;29(10):1522-1533. doi: 10.5551/jat.63226. Epub 2021 Nov 20.
Cervicocephalic atherosclerosis (AS) of patients with large-artery atherosclerotic (LAA) stroke might be more closely correlated to the functional outcome than patients with stroke of other etiologies. We aimed to investigate whether a whole-scope evaluation of cervicocephalic AS condition was better at predicting the 90-day functional outcome of LAA stroke than evaluation of intracranial or cervical AS condition alone.
Patients with LAA stroke were consecutively enrolled in this study. Computed tomography angiography was performed to evaluate AS condition of various cervicocephalic arterial segments. AS conditions ranging from no AS plaque to complete arterial occlusion scored 0-4 points. Intracranial atherosclerotic burden (IAB) and cervical atherosclerotic burden (CAB) were in respective the sums of AS scores of all intracranial arterial segments and all cervical arterial segments. And the sum of them was intracranial and cervical atherosclerotic burden (ICAB). Relationships of these three scores with the 90-day unfavorable functional outcome (modified Rankin Scale[mRS] score ＞2 points) were compared.
Of 172 patients who finished 90-day follow-up, only ICAB (adjusted odds ratio[OR]=1.10, 95% confidence interval[CI]:1.00-1.21, p=0.044) predicted 90-day unfavorable functional outcome independently of clinical factors, National Institutes of Health Stroke Scale (NIHSS) and mRS scores at admission. ICAB (adjusted hazard ratio[HR]=1.16, 95%CI:1.02-1.32, p=0.029) was related to 90-day recurrent ischemic stroke/death independently of clinical factors and was independently, positively correlated with NIHSS score at admission (r=0.16, p=0.047), whereas IAB and CAB were not.
A whole-scope evaluation of cervicocephalic AS condition using ICAB outperformed evaluation of intracranial or cervical AS condition alone in predicting 90-day functional outcome of patients with LAA stroke.
与其他病因所致卒中患者相比，大动脉粥样硬化性（LAA）卒中患者的颈颅动脉粥样硬化（AS）可能与功能结局更为密切相关。我们旨在研究全面评估颈颅 AS 状况是否优于单独评估颅内或颈内 AS 状况，更能预测 LAA 卒中患者 90 天的功能结局。
连续纳入本研究的 LAA 卒中患者。行计算机断层血管造影（CTA）评估各种颈颅动脉节段的 AS 状况。无 AS 斑块至完全动脉闭塞的 AS 状况评分 0-4 分。颅内动脉粥样硬化负担（IAB）和颈内动脉粥样硬化负担（CAB）分别为所有颅内动脉节段和所有颈内动脉节段 AS 评分的总和。它们的总和为颅内和颈内动脉粥样硬化负担（ICAB）。比较这三个评分与 90 天不良功能结局（改良 Rankin 量表[mRS]评分＞2 分）的关系。
在完成 90 天随访的 172 例患者中，只有 ICAB（调整后的优势比[OR]=1.10，95%置信区间[CI]：1.00-1.21，p=0.044）独立于临床因素、入院时的国立卫生研究院卒中量表（NIHSS）和 mRS 评分，预测 90 天不良功能结局。ICAB（调整后的危险比[HR]=1.16，95%CI：1.02-1.32，p=0.029）与 90 天内再次发生缺血性卒中和/或死亡独立相关，与入院时 NIHSS 评分独立呈正相关（r=0.16，p=0.047），而 IAB 和 CAB 则没有。
使用 ICAB 全面评估颈颅 AS 状况在预测 LAA 卒中患者 90 天功能结局方面优于单独评估颅内或颈内 AS 状况。
