A Prospective Study of Asymptomatic Intracranial Atherosclerotic Stenosis in Neurologically Normal Volunteers in a Japanese Cohort.
A Prospective Study of Asymptomatic Intracranial Atherosclerotic Stenosis in Neurologically Normal Volunteers in a Japanese Cohort.
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DOI：
10.3389/fneur.2016.00039
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发表时间：
2016
影响因子：
3.4
通讯作者：
Yamaguchi S
中科院分区：
文献类型：
--
作者：
Matsui R;Nakagawa T;Takayoshi H;Onoda K;Oguro H;Nagai A;Yamaguchi S
动脉粥样硬化性颅内动脉狭窄是亚洲缺血性中风的主要原因。然而，健康志愿者中无症状的颅内动脉粥样硬化性狭窄(ICAS)的长期预后还没有得到充分的研究。在这里，我们进行了一项纵向研究，以检查患有无症状ICAS的健康志愿者的预后，并确定ICAS的危险因素，包括无症状的脑实质损害。我们研究了2,807名健康的日本志愿者，他们没有中风病史(平均年龄62.0 岁)。平均随访时间为64.5年 个月。通过磁共振成像评估ICAS的程度和是否存在无症状的脑部病变。在首次检查时，166名志愿者(5.9%)被检测到无症状的ICAS。中度狭窄占1.5%，轻度狭窄占4.4%。ICAS的重要危险因素是年龄较大、有高血压和/或血脂异常病史。在随访期间，32名志愿者发生了缺血性中风。ICAS组共发生7次卒中，卒中发生率高于非ICAS组(每年0.78%比0.18%)。根据Cox回归分析，在调整年龄因素后，无症状的ICAS是未来缺血性卒中的独立危险因素。此外，考虑到无症状性脑损伤后，ICAS仍然是卒中发病的重要危险因素。总而言之，在健康的日本人群中，即使是轻度到中度无症状的ICAS也是未来中风的重要危险因素，与无症状的脑损害无关。轻至中度ICAS可能是预防中风的治疗靶点。
Atherosclerotic stenosis of major intracranial arteries is a leading cause of ischemic stroke in Asia. However, the long-term prognosis of asymptomatic intracranial atherosclerotic stenosis (ICAS) in healthy volunteers has not been fully examined. Here, we conducted a longitudinal study to examine the prognosis of healthy volunteers with asymptomatic ICAS and to determine the risk factors for ICAS, including asymptomatic brain parenchymal lesions. We studied 2,807 healthy Japanese volunteers with no history of stroke (mean age, 62.0 years). They were followed for a mean interval of 64.5 months. The degree of ICAS and the presence of asymptomatic brain lesions were assessed by using magnetic resonance imaging. Asymptomatic ICAS was detected in 166 volunteers (5.9%) at the initial examination. Moderate and mild stenoses were observed in 1.5 and 4.4% of patients, respectively. Significant risk factors for ICAS were older age and a history of hypertension and/or dyslipidemia. During follow-up, ischemic stroke developed in 32 volunteers. Seven strokes occurred in the ICAS group, whose stroke incidence rate was higher than that in the non-ICAS group (0.78 vs. 0.18% per year). According to a Cox regression analysis, asymptomatic ICAS was an independent risk factor for future ischemic stroke after adjustment for age. Furthermore, after asymptomatic brain lesions were taken into account, ICAS was still a significant risk factor for stroke onset. In conclusion, even mild to moderate asymptomatic ICAS was a significant risk factor for future stroke, independent of asymptomatic brain lesions, in a healthy Japanese population. Mild to moderate ICAS might be a therapeutic target for stroke prevention.