Autopsy Prevalence of Proximal Extracranial Atherosclerosis in Patients With Fatal Stroke
Autopsy Prevalence of Proximal Extracranial Atherosclerosis in Patients With Fatal Stroke
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DOI：
10.1161/strokeaha.108.514349
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发表时间：
2009-03-01
期刊：
影响因子：
8.3
通讯作者：
Amarenco, Pierre
中科院分区：
文献类型：
--
作者：
Mazighi, Mikael;Labreuche, Julien;Amarenco, Pierre
背景和目的：颅外动脉粥样硬化发生在颈动脉分叉和椎动脉V3段的近端，被认为是一种少见的预后良好的疾病。然而，由于缺乏数据，其流行率可能被低估。我们的目的是确定颈总动脉、无名动脉和锁骨下动脉以及椎动脉近端颅外斑块和狭窄的患病率。方法：我们对339例中风患者的连续尸检进行了颅内动脉、颅外动脉、主动脉弓和心脏的系统分析；脑梗死259例；80例脑出血患者作为对照组。分析了临床病史、危险因素、影像学资料和一般尸检报告。结果：近端颅外动脉斑块和狭窄发生率分别为46.9%和19.8%，脑梗死组和脑出血组差异无统计学意义。近端颅外动脉粥样硬化在椎动脉近端比其他动脉更常见（狭窄发生率为12.7%，颈总动脉为5.3%），在脑后循环梗死患者（大脑后动脉区域除外）中也更常见。更具体地说，椎动脉近端动脉粥样硬化与后循环脑梗死显著相关（经年龄和性别调整的OR为2.31，斑块组为1.28 - 4.17，狭窄组为2.10,95% CI为1.01 - 4.38），对照组为孤立性前循环梗死患者。结论：近端颅外动脉粥样硬化发生率高，与脑干梗死有显著相关性。这些发现支持了系统检查的重要性，包括评估近端颅外动脉粥样硬化病变。（中风。2009;40:713-718）
Background and Purpose-Extracranial atherosclerosis, proximal to the carotid bifurcation and V3 segment of the vertebral artery, is considered to be an infrequent condition with a benign prognosis. However, its prevalence may be underestimated due to lack of data. We aimed to determine the prevalence of proximal extracranial plaques and stenosis in the common carotid artery, innominate and subclavian arteries, and proximal vertebral artery.Methods-We performed a systematic analysis of intra- and extracranial arteries, the aortic arch, and the heart in 339 consecutive autopsies of patients with stroke; 259 patients had brain infarction; 80 patients had brain hemorrhage and were used as control subjects. Clinical history, risk factors, imaging data, and general autopsy reports were analyzed.Results-Proximal extracranial plaques and stenosis were present in the arteries of 46.9% and 19.8% of patients, respectively, without a significant difference between brain infarction and brain hemorrhage groups. Proximal extracranial atherosclerosis occurred more frequently in the proximal vertebral artery than in other arteries (stenosis prevalence 12.7% versus 5.3% in the common carotid artery) and in patients with posterior circulation brain infarction (except for the posterior cerebral artery territory). More specifically, atherosclerosis in the proximal vertebral artery was significantly associated with posterior circulation brain infarction (age- and sex-adjusted OR, 2.31; 95% CI, 1.28 to 4.17 for plaques and 2.10; 95% CI, 1.01 to 4.38 for stenosis) using patients with isolated anterior circulation infarctions as control subjects.Conclusions-Proximal extracranial atherosclerosis was frequent and was significantly associated with brainstem infarcts. These findings support the importance of a systematic workup, including the evaluation of proximal extracranial atherosclerotic lesions. (Stroke. 2009; 40: 713-718.)