Martinez-Viguera Ana, Xuclà-Ferrarons Tomàs, Collet Roger, Olmedo-Saura Gonzalo, Martí-Fàbregas Joan, Izquierdo Artur, Martínez-Domeño Alejandro, Prats-Sánchez Luis, Guasch-Jiménez Marina, Guisado-Alonso Daniel, Ramos-Pachón Anna, Camps-Renom Pol
Department of Neurology, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Maria Claret 167, Barcelona 08025, Spain.
Department of Neurology, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Maria Claret 167, Barcelona 08025, Spain.
J Stroke Cerebrovasc Dis. 2023 Nov;32(11):107335. doi: 10.1016/j.jstrokecerebrovasdis.2023.107335. Epub 2023 Sep 23.
Whether presenting an episode of amaurosis fugax (AFx) increases the risk of ischemic stroke is controversial and there is a lack of consensus in the following management. We aimed to describe the clinical characteristics and prognosis of patients with AFx due to suspected transient retinal ischemia.
Observational, retrospective study of patients admitted in a Comprehensive Stroke Center with diagnosis of AFx due to suspected transient retinal ischemia between 2015 and 2020. Clinical characteristics and diagnostic-therapeutic data were collected, as well as recurrences (new episodes of amaurosis and/or ischemic strokes). Multivariable Cox regression analyses were performed to study factors associated with the risk of recurrence.
We included 91 patients with a mean age of 67.9±14.8 years, 43(47.3%) were women. After the diagnostic workup 14(15.4%) AFx were attributed to an atherothrombotic etiology, 4(4.4%) cardioembolic source, 10(11%) other determined cause (TOAST-OC) and 63(69,2%) indeterminate etiology. 71(78%) patients started antiplatelet therapy and 2(2.2%) anticoagulant therapy. After a median follow-up of 3.5 years (IQR 1.8-5.2), at least one recurrence was recorded in eight (8.8%) patients (four new AFx and four cerebral infarctions). TOAST-OC (HR=9.66, 95% CI 2.41-38.70; p=0.001) and prior history of ischemic stroke (HR=4.21. 95% CI 1.01-17.66; p=0.049) were both independently associated with the risk of recurrence.
In two out of three patients, AFx due to transient retinal ischemia was of undetermined cause. The risk of stroke recurrence after a first episode of AFx in our cohort was 8.8%. Patients with TOAST-OC etiology identified were at highest risk of recurrence.
出现一过性黑矇（AFx）是否会增加缺血性卒中风险存在争议，且后续管理缺乏共识。我们旨在描述疑似短暂性视网膜缺血所致AFx患者的临床特征及预后。
对2015年至2020年间在综合卒中中心因疑似短暂性视网膜缺血诊断为AFx而入院的患者进行观察性回顾性研究。收集临床特征及诊断治疗数据，以及复发情况（新的一过性黑矇发作和/或缺血性卒中）。进行多变量Cox回归分析以研究与复发风险相关的因素。
我们纳入了91例患者，平均年龄67.9±14.8岁，43例（47.3%）为女性。经过诊断检查，14例（15.4%）AFx归因于动脉粥样硬化血栓形成病因，4例（4.4%）为心源性栓塞源，10例（11%）为其他确定病因（TOAST-OC），63例（69.2%）病因不明。71例（78%）患者开始抗血小板治疗，2例（2.2%）开始抗凝治疗。中位随访3.5年（四分位间距1.8 - 5.2年）后，8例（8.8%）患者记录到至少一次复发（4例新的AFx和4例脑梗死）。TOAST-OC（HR = 9.66，95%CI 2.41 - 38.70；p = 0.001）和既往缺血性卒中病史（HR = 4.21，95%CI 1.01 - 17.66；p = 0.049）均与复发风险独立相关。
三分之二因短暂性视网膜缺血所致AFx患者的病因不明。在我们的队列中，首次AFx发作后卒中复发风险为8.8%。确定为TOAST-OC病因的患者复发风险最高。
