Chronic Hemodynamic Compromise and Cerebral Ischemic Events in Asymptomatic or Remote Symptomatic Large-Artery Intracranial Occlusive Disease
Chronic Hemodynamic Compromise and Cerebral Ischemic Events in Asymptomatic or Remote Symptomatic Large-Artery Intracranial Occlusive Disease
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DOI：
10.3174/ajnr.a3491
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发表时间：
2013-09-01
影响因子：
3.5
通讯作者：
Takahashi, M.
中科院分区：
文献类型：
--
作者：
Yamauchi, H.;Higashi, T.;Takahashi, M.
背景和目的：在无症状或远程症状的 LAICOD 中，缺血事件的风险总体较低，但可能存在一个需要积极医疗管理的高风险患者亚组。本研究的目的是确定慢性血流动力学损害是否是无症状或远期症状 LAICOD 缺血事件的预测因素。 材料和方法：我们使用 O-15-PET 前瞻性研究了 51 名无症状、19 名共存无症状和 19 名远期（>6 个月）有症状的颅内颈内动脉或大脑中动脉动脉粥样硬化患者。 MP 定义为 CBF 减少、OEF 增加和 CBF/CBV 比率降低。所有患者均随访2年或直至发生卒中或TIA或死亡。结果：4例患者进行搭桥手术（2例患有MP）。 3 例脑缺血事件（无症状患者 1 例 TIA，1 例中风，远期症状患者 1 例 TIA）发生在 LAICOD 同侧血管区域。搭桥手术时进行删失的 Kaplan-Meier 分析显示，有 MP 的患者同侧缺血事件的发生率 (2/5) 显着高于无 MP 的患者 (1/84)（对数秩检验；P < .0001）。 MP 赋予的相对风险为 83.1（95% 置信区间，6.8-1017.4；P < .001）。 CBF/CBV 降低的患者同侧缺血事件的发生率 (2/9) 也显着高于无 CBF/CBV 降低的患者 (1/80) (P = .0001)。 结论：慢性血流动力学损害可能是无症状和远期症状 LAICOD 缺血事件的预测因子。
BACKGROUND AND PURPOSE: In asymptomatic or remote symptomatic LAICOD, the risk of ischemic events is low in general, but there may be a subgroup of higher risk patients who require aggressive medical management. The purpose of this study was to determine whether chronic hemodynamic compromise is a predictor of ischemic events in asymptomatic or remote symptomatic LAICOD.MATERIALS AND METHODS: We prospectively studied 51 asymptomatic, 19 coexistent asymptomatic, and 19 remote (>6 months) symptomatic patients with atherosclerotic intracranial internal carotid artery or middle cerebral artery disease by using O-15-PET. MP was defined as decreased CBF, increased OEF, and a decreased CBF/CBV ratio. All patients were followed up for 2 years or until occurrence of stroke or TIA or death.RESULTS: Bypass surgery was performed in 4 patients (2 with MP). Three cerebral ischemic events (1 TIA in an asymptomatic patient, 1 stroke, and 1 TIA in a remote symptomatic patient) occurred in the vascular territory ipsilateral to LAICOD. Kaplan-Meier analysis with censoring at the time of bypass surgery revealed that the incidence of ipsilateral ischemic events in patients with MP (2/5) was significantly higher than that in patients without MP (1/84) (log-rank test; P < .0001). The relative risk conferred by MP was 83.1 (95% confidence interval, 6.8-1017.4; P < .001). The incidence of ipsilateral ischemic events in patients with decreased CBF/CBV (2/9) was also significantly higher than that of patients without it (1/80) (P = .0001).CONCLUSIONS: Chronic hemodynamic compromise may be a predictor of ischemic events in both asymptomatic and remote symptomatic LAICOD.