Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion
Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion
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DOI：
10.1001/jama.280.12.1055
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发表时间：
1998-09-30
影响因子：
120.7
通讯作者：
Powers, WJ
中科院分区：
文献类型：
--
作者：
Grubb, RL;Derdeyn, CP;Powers, WJ
背景。-血流动力学因素在颈动脉闭塞患者卒中发病机制和治疗中的相对重要性仍然存在争议。为了检验这一假设，即第二阶段脑血流动力学衰竭（正电子发射断层扫描[PET]测量的氧提取增加）远端症状性颈动脉闭塞是一个独立的危险因素，为后续中风的药物治疗的patients.Design和设置。对1992年至1996年间从一组地区医院转诊的患者进行的前瞻性、盲法、纵向队列研究。从419例受试者中，入组了81例既往在闭塞颈动脉区域发生卒中或短暂性脑缺血发作的受试者。所有患者均随访至研究完成，平均随访时间为31.5个月。主要结果指标每6个月电话联系一次，记录所有卒中、同侧缺血性卒中和死亡的后续发生情况。39例II期血流动力学衰竭患者中有12例发生卒中，42例无II期血流动力学衰竭患者中有3例发生卒中（P= 0.005）; 39例II期血流动力学衰竭患者中有11例发生卒中，42例无II期血流动力学衰竭患者中有2例发生卒中（P= 0.004）。每组各有6例死亡（P= 0.94）。年龄校正后II期血流动力学衰竭的相对风险为6.0（95%置信区间[CI]，1.7-21.6），所有卒中为7.3（95% CI，1.6-33.4）。II期血流动力学衰竭定义了症状性颈动脉闭塞患者的亚组，这些患者在接受药物治疗时具有后续卒中的高风险，需要进行一项随机试验来评估该高危亚组的手术血运重建。
Context.-The relative importance of hemodynamic factors in the pathogenesis and treatment of stroke in patients with carotid artery occlusion remains controversial.Objective.-To test the hypothesis that stage II cerebral hemodynamic failure (increased oxygen extraction measured by positron emission tomography [PET]) distal to symptomatic carotid artery occlusion is an independent risk factor for subsequent stroke in medically treated patients.Design and Setting.-Prospective, blinded, longitudinal cohort study of patients referred from a group of regional hospitals between 1992 and 1996,Patients.-From 419 subjects referred, 81 with previous stroke or transient ischemic attack in the territory of an occluded carotid artery were enrolled. All were followed up to completion of the study, with average follow-up of 31.5 months.Main Outcome Measures.-Telephone contact every 6 months recorded the subsequent occurrence of all stroke, ipsilateral ischemic stroke, and death.Results.-Stroke occurred in 12 of 39 patients with stage II hemodynamic failure and in 3 of 42 patients without (P=.005); stroke was ipsilateral in 11 of 39 patients with stage II hemodynamic failure and in 2 of 42 patients without (P=.004). Six deaths occurred in each group (P=.94). The age-adjusted relative risk conferred by stage II hemodynamic failure was 6.0 (95% confidence interval [CI], 1.7-21.6) for all stroke and 7.3 (95% CI, 1.6-33.4) for ipsilateral stroke.Conclusions.-Stage II hemodynamic failure defines a subgroup of patients with symptomatic carotid occlusion who are at high risk for subsequent stroke when treated medically, A randomized trial evaluating surgical revascularization in this high-risk subgroup is warranted.