Liu Wan-Yun Sabrina, Narasimhalu Kaavya, Woon Fung Peng, Allen John Carson, De Silva Deidre Anne
Duke-NUS Medical School, Singapore.
Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore.
Singapore Med J. 2024 Sep 3. doi: 10.4103/singaporemedj.SMJ-2023-063.
Intracranial large artery disease (ICLAD) is a common cause of ischaemic stroke and is associated with the risk of recurrent vascular events in the short term. We compared the incidence of various long-term vascular outcomes between ischaemic stroke patients with and without ICLAD.
This was a longitudinal observational study of acute ischaemic stroke patients who were followed up serially for recurrent stroke, myocardial infarction or vascular death up to a median of 86 months. Transcranial colour-coded Doppler was used in the diagnosis of ICLAD.
Among the 581 ischaemic stroke patients studied (median age 63 ± 11 years, male 71%), 354 (60.9%) had ICLAD. In regression analyses adjusting for covariates, patients with ICLAD were more likely to have long-term composite vascular outcomes (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.02-2.03, P = 0.041), myocardial infarction (HR 2.89, 95% CI 1.71-4.91, P < 0.001) and vascular death (HR 3.52, 95% CI 1.67-7.52, P = 0.001) but not recurrent stroke (HR 1.10, 95% CI 0.72-1.70, P = 0.652), at a median of 86 months as compared to patients without ICLAD.
Our findings of poor prognostic impact of ICLAD on long-term recurrent vascular events after ischaemic stroke provide evidence for the need of specific, emphasised screening and secondary prevention, especially for coronary artery disease in this high-risk group.
颅内大动脉疾病（ICLAD）是缺血性卒中的常见病因，且与短期内复发性血管事件风险相关。我们比较了有和没有ICLAD的缺血性卒中患者各种长期血管结局的发生率。
这是一项对急性缺血性卒中患者的纵向观察性研究，对患者进行连续随访，以观察复发性卒中、心肌梗死或血管性死亡，随访时间中位数达86个月。经颅彩色编码多普勒用于ICLAD的诊断。
在研究的581例缺血性卒中患者中（中位年龄63±11岁，男性占71%），354例（60.9%）患有ICLAD。在对协变量进行校正的回归分析中，与没有ICLAD的患者相比，患有ICLAD的患者在86个月时更有可能出现长期复合血管结局（风险比[HR]1.44，95%置信区间[CI]1.02 - 2.03，P = 0.041）、心肌梗死（HR 2.89，95% CI 1.71 - 4.91，P < 0.001）和血管性死亡（HR 3.52，95% CI 1.67 - 7.52，P = 0.001），但复发性卒中的发生率无差异（HR 1.10，95% CI 0.72 - 1.70，P = 0.652）。
我们的研究结果表明，ICLAD对缺血性卒中后长期复发性血管事件的预后影响较差，这为针对这一高危人群进行特定的、重点的筛查和二级预防提供了证据，尤其是针对冠状动脉疾病。
