Effect of Hemodynamics on Stroke Risk in Symptomatic Atherosclerotic Vertebrobasilar Occlusive Disease.
Effect of Hemodynamics on Stroke Risk in Symptomatic Atherosclerotic Vertebrobasilar Occlusive Disease.
复制标题
血液动力学对有症状的动脉粥样硬化脊椎囊肿性疾病中卒中风险的影响。
DOI：
10.1001/jamaneurol.2015.3772
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发表时间：
2016-02
期刊：
影响因子：
29
通讯作者：
Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke Study Group
中科院分区：
文献类型：
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作者：
Amin-Hanjani S;Pandey DK;Rose-Finnell L;Du X;Richardson D;Thulborn KR;Elkind MS;Zipfel GJ;Liebeskind DS;Silver FL;Kasner SE;Aletich VA;Caplan LR;Derdeyn CP;Gorelick PB;Charbel FT;Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke Study Group
动脉粥样硬化性椎基底动脉（VB）闭塞性疾病是后循环卒中的重要病因，局部低灌注是卒中风险的重要潜在因素。检验以下假设：在有症状的VB狭窄或闭塞患者中，通过大血管定量磁共振血管造影（QMRA）测量的远端血流受损患者随后发生后循环卒中的风险较高。在美国和加拿大的5家学术医院中心进行了一项前瞻性、设盲、纵向队列研究;入组了82例住院和门诊患者。近期VB短暂性脑缺血发作或卒中且椎动脉和/或基底动脉粥样硬化性狭窄或闭塞≥ 50%的受试者使用QMRA在VB区域进行大血管流量测量。进行随访评估的医生对QMRA血流状态不知情。随访包括每月电话随访12个月和半年一次的临床访视（最短12个月，最长24个月或最终访视）。入组时间为2008年7月1日至2013年7月31日，研究于2014年6月30日完成;数据分析时间为2014年10月1日至2015年4月10日。中风危险因素的标准医疗管理。主要结局为VB区卒中。在82例入组患者中，72例在中心审查其血管造影片后仍合格。72例患者中有69例完成了至少12个月的随访;中位随访时间为23个月（四分位距，14-25）。在分析的72名参与者中，18名（25%）的远端血流状态较低，与随后的VB卒中风险显著相关（P = 0.04），低血流组12个月和24个月的无事件生存率分别为78%和70%，而正常血流组分别为96%和87%。经年龄和卒中危险因素校正后，低远端血流状态组的风险比为11.55（95%CI，1.88-71.00; P = 0.008）。远端血流低和正常的患者之间6个月间隔的医疗风险因素管理相似。即使控制狭窄程度和位置，远端血流状态仍与风险显著相关。在有症状的动脉粥样硬化性VB闭塞性疾病患者中，使用无创和实用的成像工具确定的远端血流状态与随后卒中的风险显著相关。高风险患者的识别对于未来更积极的介入或药物治疗的研究具有重要意义。
Atherosclerotic vertebrobasilar (VB) occlusive disease is a significant etiology of posterior circulation stroke, with regional hypoperfusion as an important potential contributor to stroke risk. To test the hypothesis that, among patients with symptomatic VB stenosis or occlusion, those with distal blood flow compromise as measured by large-vessel quantitative magnetic resonance angiography (QMRA) are at higher risk of subsequent posterior circulation stroke. A prospective, blinded, longitudinal cohort study was conducted at 5 academic hospital-based centers in the United States and Canada; 82 patients from inpatient and outpatient settings were enrolled. Participants with recent VB transient ischemic attack or stroke and 50% or more atherosclerotic stenosis or occlusion in vertebral and/or basilar arteries underwent large-vessel flow measurement in the VB territory using QMRA. Physicians performing follow-up assessments were blinded to QMRA flow status. Follow-up included monthly telephone calls for 12 months and biannual clinical visits (for a minimum of 12 months, and up to 24 months or the final visit). Enrollment took place from July 1, 2008, to July 31, 2013, with study completion on June 30, 2014; data analysis was performed from October 1, 2014, to April 10, 2015. Standard medical management of stroke risk factors. The primary outcome was VB-territory stroke. Of the 82 enrolled patients, 72 remained eligible after central review of their angiograms. Sixty-nine of 72 patients completed the minimum 12-month follow-up; median follow-up was 23 (interquartile range, 14–25) months. Distal flow status was low in 18 of the 72 participants (25%) included in the analysis and was significantly associated with risk for a subsequent VB stroke (P = .04), with 12- and 24-month event-free survival rates of 78% and 70%, respectively, in the low-flow group vs 96% and 87%, respectively, in the normal-flow group. The hazard ratio, adjusted for age and stroke risk factors, in the low distal flow status group was 11.55 (95% CI, 1.88–71.00; P = .008). Medical risk factor management at 6-month intervals was similar between patients with low and normal distal flow. Distal flow status remained significantly associated with risk even when controlling for the degree of stenosis and location. Distal flow status determined using a noninvasive and practical imaging tool is robustly associated with risk for subsequent stroke in patients with symptomatic atherosclerotic VB occlusive disease. Identification of high-risk patients has important implications for future investigation of more aggressive interventional or medical therapies.