Salgado A V, Ferro J M, Gouveia-Oliveira A
Department of Neurology, Hospital St. Maria, Lisbon, Portugal.
Stroke. 1996 Apr;27(4):661-6. doi: 10.1161/01.str.27.4.661.
Information concerning the long-term prognosis of lacunar strokes is still limited and has shown different results. The aim of this study was to investigate the long-term prognosis of first-ever lacunar strokes and the possible role of clinical prognostic factors and different pathogenic mechanisms.
Between March 1990 and November 1993, a cohort of consecutive patients presenting with first-ever lacunar infarcts was prospectively evaluated after stroke onset at day 0 to 3 and/or day 7, every 3 months up to 1 year, and every 6 months thereafter. All patients were studied according to a protocol that included demographic and clinical data, neurological examination, Toronto Stroke Scale, Barthel Index, Rankin Scale, CT scan, routine laboratory workup, electrocardiogram, carotid duplex scanning, and echocardiogram. More recently, patients have also been evaluated with transcranial Doppler ultrasonography. Recurrent strokes, myocardial infarction, and death were registered through direct observation, chart review, or interviews with the attending physician or family members.
One hundred forty-five patients-94 (65%) with pure hemiparesis, 33 (23%) with sensorimotor stroke, 11 (8%) with ataxic hemiparesis, 5 (3%) with pure sensory stroke, and 2(1%) with dysarthria-clumsy hand syndrome-were followed for a median period of 39 months. During follow-up ther were 17 deaths (3 vascular), 30 recurrent strokes (1 fatal), and 4 myocardial infarctions. Five-year survival rate free of recurrent stroke was 63% (95% confidence interval [CI], 52% to 73%), while 5-year survival rate was 86% (95% CI, 78% to 91%). Cox proportional hazards analysis showed that age (p=.02) was the only significant predictor of survival free of recurrent stroke. Age (P<.001) and the degree of neurological dysfunction and functional disability at 7 days after the index stroke measured by the Toronto Stroke Scale (P=.05) and a Barthel Index score <40 (P=.04) were the only significant predictors of death. The 5-year probability rate of stroke-free recurrence was 72% (95% CI, 60% to 81%). Sixty-three percent of the first recurrent strokes were lacunar infarcts. When clinical, laboratory, and CT data as well as possible etiopathogenic mechanisms of lacunar strokes were considered, Cox proportional hazards analysis could not identify any predictor of stroke recurrence.
Our study confirms that lacunar infarcts are associated with low stroke recurrence and mortality rates. In our series, the majority of first recurrent strokes were also lacunar infarcts. Age, degree of neurological dysfunction, and functional disability at day 7 after the index stroke were significant predictors of death.
关于腔隙性卒中长期预后的信息仍然有限，且结果各异。本研究旨在探讨首次腔隙性卒中的长期预后以及临床预后因素和不同致病机制的可能作用。
在1990年3月至1993年11月期间，对一组首次发生腔隙性梗死的连续患者进行前瞻性评估，在卒中发作后第0至3天和/或第7天、至1年时每3个月、此后每6个月进行评估。所有患者均按照包含人口统计学和临床数据、神经学检查、多伦多卒中量表、巴氏指数、Rankin量表、CT扫描、常规实验室检查、心电图、颈动脉双功超声扫描和超声心动图的方案进行研究。最近，患者还接受了经颅多普勒超声检查。复发性卒中、心肌梗死和死亡通过直接观察、病历审查或与主治医生或家庭成员访谈进行记录。
145例患者——94例（65%）为单纯偏瘫，33例（23%）为感觉运动性卒中，11例（8%）为共济失调性偏瘫，5例（3%）为纯感觉性卒中，2例（1%）为构音障碍-手笨拙综合征——中位随访期为39个月。随访期间有17例死亡（3例为血管性）、30例复发性卒中（1例致命）和4例心肌梗死。无复发性卒中的5年生存率为63%（95%置信区间[CI]，52%至73%），而5年生存率为86%（95%CI，78%至91%）。Cox比例风险分析表明，年龄（p = 0.02）是无复发性卒中生存的唯一显著预测因素。年龄（P < 0.001）、卒中发作后7天通过多伦多卒中量表测量的神经功能障碍程度和功能残疾程度（P = 0.05）以及巴氏指数评分<40（P = 0.04）是死亡的唯一显著预测因素。无卒中复发的5年概率为72%（95%CI，60%至81%）。63%的首次复发性卒中为腔隙性梗死。当考虑腔隙性卒中的临床、实验室和CT数据以及可能的病因机制时，Cox比例风险分析未能识别出任何卒中复发的预测因素。
我们的研究证实腔隙性梗死与低卒中复发率和死亡率相关。在我们的系列研究中，大多数首次复发性卒中也是腔隙性梗死。指数卒中后第7天的年龄、神经功能障碍程度和功能残疾是死亡的显著预测因素。
