Neurology Unit, Department of Neuroscience, S.Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy.
IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Cerebrovasc Dis. 2023;52(2):218-225. doi: 10.1159/000525954. Epub 2022 Sep 9.
Features and prognosis of capsular warning syndrome (CWS) have been poorly investigated prospectively.
The study aimed to characterize CWS clinical features, risk profile, short- and long-term prognosis, among a large TIA cohort.
Prospective cohort study of consecutive TIAs was conducted from August 1, 2010, to December 31, 2017. Demographic and clinical characteristics, risk profile, primary (stroke and composite outcome) and secondary (TIA recurrence, cerebral hemorrhage, new onset atrial fibrillation) outcomes were compared between CWS, lacunar (L), and nonlacunar (NL) TIAs.
1,035 patients (33 CWS, 189 L-TIAs, 813 NL-TIAs) were enrolled. Newly diagnosed (ND) hypertension, hypercholesterolemia, cigarette smoking, and leukoaraiosis were independent risk factors of CWS (p < 0.05). CWS showed the highest stroke (30.3% vs. 0.5% and 1.5% for L-TIAs and NL-TIAs, respectively) and composite outcome risk at follow-up (p < 0.001), but better 3-month post-stroke prognosis (mRS 0-2 90.0% vs. 36.8%; p = 0.002). CWS-related stroke mostly occurred <48 h (80.0%) and had a small vessel occlusion etiology (100%), affecting more often the internal capsule (60.0%). Dual antiplatelet therapy (DAPT) versus single antiplatelet therapy was associated with lower 3-month cumulative stroke incidence (12.5% vs. 57.1%; p = 0.010). Intravenous thrombolysis (IVT) showed similar 3-month efficacy and safety in strokes after TIAs groups (median mRS 0, IQR 0-1; p = 0.323).
CWS is associated with higher stroke risk and better functional prognosis than L- and NL-TIAs. CWS risk profile is consistent with severe small vessel disease, and ND hypertension could represent a major risk factor. DAPT and IVT seem effective and safe in preventing and treating stroke following CWS.
Capsular warning 综合征（CWS）的特征和预后在前瞻性研究中研究得并不充分。
本研究旨在描述 CWS 的临床特征、风险概况、短期和长期预后，研究对象为一大群 TIA 患者。
连续 TIA 患者的前瞻性队列研究于 2010 年 8 月 1 日至 2017 年 12 月 31 日进行。比较 CWS、腔隙性（L）和非腔隙性（NL）TIA 之间的人口统计学和临床特征、风险概况、主要（中风和复合结局）和次要（TIA 复发、脑出血、新发心房颤动）结局。
共纳入 1035 例患者（33 例 CWS、189 例 L-TIA、813 例 NL-TIA）。新发诊断（ND）高血压、高胆固醇血症、吸烟和脑白质疏松症是 CWS 的独立危险因素（p<0.05）。CWS 在随访期间表现出最高的中风（30.3% vs. 0.5%和 1.5%，分别为 L-TIA 和 NL-TIA）和复合结局风险（p<0.001），但在中风后 3 个月有更好的预后（mRS 0-2 90.0% vs. 36.8%；p=0.002）。CWS 相关中风主要发生在<48 h（80.0%），且病因是小血管闭塞（100%），更常影响内囊（60.0%）。双联抗血小板治疗（DAPT）与单药抗血小板治疗相比，3 个月累积中风发生率较低（12.5% vs. 57.1%；p=0.010）。静脉溶栓（IVT）在 TIA 后各组中风患者中具有相似的 3 个月疗效和安全性（中位数 mRS 0，IQR 0-1；p=0.323）。
CWS 与更高的中风风险和比 L-和 NL-TIA 更好的功能预后相关。CWS 的风险概况与严重的小血管疾病一致，新发高血压可能是一个主要的危险因素。DAPT 和 IVT 似乎在预防和治疗 CWS 后中风方面是有效和安全的。
