Predictors of Recurrent Stroke in Patients With Symptomatic Intracranial Arterial Stenosis
Predictors of Recurrent Stroke in Patients With Symptomatic Intracranial Arterial Stenosis
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DOI：
10.1161/strokeaha.112.659185
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发表时间：
2012-10-01
期刊：
影响因子：
8.3
通讯作者：
Kwon, Sun U.
中科院分区：
文献类型：
--
作者：
Jung, Jin-Man;Kang, Dong-Wha;Kwon, Sun U.
背景和目的--我们的目标是研究最初的缺血病变模式是否能够预测症状性颅内动脉狭窄患者的卒中复发。方法：在西洛他唑治疗症状性颅内动脉狭窄(TOSS)-2试验参与者中，我们纳入了在基线上接受扩散加权成像和液体衰减反转恢复成像的患者，并在7个月时进行了随访液体衰减反转恢复成像。根据弥散加权成像结果，我们根据部位(皮质下、皮质下、皮质下)和多样性(单发、多发)对最初的缺血性损害模式进行了分类。结果：在353例患者中，44例(12.5%)患者在最初的症状性颅内动脉狭窄区域有新的缺血病变，13例(3.7%)患者有临床复发卒中。多因素分析显示，皮质下病变和多发性病变是症状性颅内动脉狭窄区新的缺血性病变的独立预测因素(OR3.01；95%CI1.33~7.01；P=0.03；OR2.81；95%CI1.34~5.9；P=0.006)。结论皮质下病变和多发病变是有症状的颅内动脉狭窄患者复发缺血性卒中的放射学预测指标。
Background and Purpose-Our goal was to investigate whether initial ischemic lesion pattern can predict stroke recurrence in patients with symptomatic intracranial arterial stenosis.Methods-Of the Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS)-2 trial participants, we included patients who underwent diffusion-weighted imaging and fluid attenuation inversion recovery imaging at baseline with a follow-up fluid attenuation inversion recovery imaging at 7 months. Based on the diffusion-weighted imaging findings, we classified the initial ischemic lesion patterns according to location (subcortical versus cortical versus subcorticocortical) and multiplicity (single versus multiple). We also evaluated the occurrence of new ischemic lesions on follow-up fluid attenuation inversion recovery as well as clinical stroke in the symptomatic intracranial arterial stenosis territory.Results-Of 353 patients included in this study, 44 (12.5%) and 13 (3.7%) patients had new ischemic lesions and clinical recurrent stroke in the initial symptomatic intracranial arterial stenosis territory, respectively. On multivariable analysis, the initial lesion patterns of subcorticocortical and multiple lesions were independent predictors of new ischemic lesions in the symptomatic intracranial arterial stenosis territory (OR, 3.01; 95% CI, 1.33-7.01; P=0.03; OR, 2.81; 95% CI, 1.34-5.9; P=0.006). These patterns also predicted clinical recurrent stroke.Conclusion-Subcorticocortical lesions and multiple lesions are radiological predictors of recurrent ischemic stroke in symptomatic patients with intracranial arterial stenosis.