颈内动脉夹层闭塞自发再通对中风风险的影响。
Impact of spontaneous recanalization of occlusive cervical artery dissection on risk of stroke.
作者信息
Mayer-Suess Lukas, Kaufmann Josefin E, Scherer Lukas, Karisik Anel, Galijasevic Malik, Mangesius Stephanie, Gizewski Elke Ruth, Kiechl Stefan, Traenka Christopher, Engelter Stefan T, Knoflach Michael
机构信息
Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
出版信息
J Neurol. 2025 Sep 11;272(9):627. doi: 10.1007/s00415-025-13371-y.
INTRODUCTION
Occlusive cervical artery dissection (CeAD) is associated with worse patient outcome. The net clinical benefit of acute revascularization measures has to be weighed against the likelihood of spontaneous recanalization. Our aim was to assess the hitherto un-addressed impact of spontaneous recanalization on stroke risk in patients with occlusive CeAD.
METHODS
MRI verified CeAD patients with initially occlusive CeAD within cohort study that did not undergo acute revascularization measures were assessed. Follow-up data derived from clinical routine and study specific assessments. Outcomes of interest were occurrence of (i) recanalization and (ii) ischemic stroke upstream of CeAD-related occlusion. Adjusted logistic regression analysis addressed the impact of recanalization on said outcomes.
RESULTS
97/328 (29.6%) patients had occlusive CeAD and did not undergo acute revascularization treatment. Upon follow-up, 56/97 (57.7%) showed spontaneous recanalization of initially occlusive CeAD. Female sex (OR 0.41[0.18, 0.97]; P = 0.043) and internal carotid artery dissection (OR 0.33[0.14, 0.78]; P = 0.012) were the only factors independently associated with recanalization. Within a median follow-up of 8.2 (1.58, 12.8) years, a total of 18/97 (18.6%) patients suffered ischemic stroke upstream of the initially CeAD-affected vessel. After adjusting for confounders, spontaneous recanalization was independently associated with lower rates of cerebral ischemia upon follow-up (OR 0.28[0.09, 0.90]; P = 0.032), most notably also independent of type of antithrombotic treatment.
CONCLUSIONS
Spontaneous recanalization in occlusive CeAD is associated with lower rates of stroke upon follow-up. These results indicate that persistent CeAD-related occlusion remains a risk-factor for recurrent ischemic events, thus calling for future trials addressing optimal medical treatment.
TRIAL REGISTRATION
N/A.
GUARANTOR
Lukas Mayer-Suess.
引言
闭塞性颈内动脉夹层（CeAD）与患者预后较差相关。急性血运重建措施的净临床益处必须与自发再通的可能性相权衡。我们的目的是评估自发再通对闭塞性CeAD患者中风风险的影响，这一影响此前尚未得到研究。
方法
在队列研究中，对MRI证实的最初为闭塞性CeAD且未接受急性血运重建措施的患者进行评估。随访数据来自临床常规和特定研究评估。感兴趣的结果是（i）再通的发生情况，以及（ii）CeAD相关闭塞上游的缺血性中风。调整后的逻辑回归分析探讨了再通对上述结果的影响。
结果
97/328（29.6%）例患者患有闭塞性CeAD且未接受急性血运重建治疗。随访时，56/97（57.7%）例患者最初闭塞的CeAD出现自发再通。女性（OR 0.41[0.18, 0.97]；P = 0.043）和颈内动脉夹层（OR 0.33[0.14, 0.78]；P = 0.012）是与再通独立相关的唯一因素。在中位随访8.2（1.58, 12.8）年期间，共有18/97（18.6%）例患者在最初受CeAD影响的血管上游发生缺血性中风。在对混杂因素进行调整后，自发再通与随访时较低的脑缺血发生率独立相关（OR 0.28[0.09, 0.90]；P = 0.032），最显著的是，这也与抗血栓治疗类型无关。
结论
闭塞性CeAD的自发再通与随访时较低的中风发生率相关。这些结果表明，持续性CeAD相关闭塞仍然是复发性缺血事件的危险因素，因此需要开展未来试验以探讨最佳药物治疗方案。
试验注册
无。
担保人
卢卡斯·迈尔 - 苏斯。
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