Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion.
Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion.
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DOI：
10.1097/00008506-199904000-00018
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发表时间：
1999-04
期刊：
影响因子：
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通讯作者：
R. Grubb;C. Derdeyn;S. M. Fritsch;D. Carpenter;K. Yundt;T. Videen;E. Spitznagel;W. Powers
中科院分区：
文献类型：
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作者：
R. Grubb;C. Derdeyn;S. M. Fritsch;D. Carpenter;K. Yundt;T. Videen;E. Spitznagel;W. Powers
背景 血流动力学因素在颈动脉闭塞患者卒中发病机制和治疗中的相对重要性仍存在争议。目的 检验以下假设：症状性颈动脉闭塞远端的 II 期脑血流动力学衰竭（通过正电子发射断层扫描 [PET] 测量的吸氧量增加）是接受药物治疗的患者随后发生卒中的独立危险因素。设计和设置 对 1992 年至 1996 年间从一组地区医院转诊的患者进行前瞻性、盲法、纵向队列研究。患者 在 419 名转诊受试者中，81 名既往有过中风或颈动脉闭塞区域短暂性脑缺血发作的患者被纳入。所有患者均接受随访直至研究完成，平均随访时间为 31.5 个月。主要观察指标 每6个月电话联系一次，记录随后发生的所有卒中、同侧缺血性卒中和死亡情况。结果 39 名 II 期血流动力学衰竭患者中有 12 名发生中风，42 名没有 II 期血流动力学衰竭的患者中有 3 名发生中风 (P = .005)； 39 名 II 期血流动力学衰竭患者中有 11 名发生同侧卒中，42 名没有 II 期血流动力学衰竭的患者中有 2 名发生同侧卒中（P = .004）。每组均发生 6 例死亡 (P = .94)。对于所有卒中，II 期血流动力学失败带来的年龄调整相对风险为 6.0（95% 置信区间 [CI]，1.7-21.6）；对于同侧卒中，年龄调整相对风险为 7.3（95% CI，1.6-33.4）。结论 II 期血流动力学衰竭定义为有症状颈动脉闭塞的患者亚组，这些患者在接受药物治疗后发生卒中的风险很高。有必要进行一项随机试验来评估这一高风险亚组的手术血运重建。
CONTEXT The relative importance of hemodynamic factors in the pathogenesis and treatment of stroke in patients with carotid artery occlusion remains controversial. OBJECTIVE To test the hypothesis that stage II cerebral hemodynamic failure (increased oxygen extraction measured by positron emission tomography [PET]) distal to symptomatic carotid artery occlusion is an independent risk factor for subsequent stroke in medically treated patients. DESIGN AND SETTING Prospective, blinded, longitudinal cohort study of patients referred from a group of regional hospitals between 1992 and 1996. PATIENTS From 419 subjects referred, 81 with previous stroke or transient ischemic attack in the territory of an occluded carotid artery were enrolled. All were followed up to completion of the study, with average follow-up of 31.5 months. MAIN OUTCOME MEASURES Telephone contact every 6 months recorded the subsequent occurrence of all stroke, ipsilateral ischemic stroke, and death. RESULTS Stroke occurred in 12 of 39 patients with stage II hemodynamic failure and in 3 of 42 patients without (P = .005); stroke was ipsilateral in 11 of 39 patients with stage II hemodynamic failure and in 2 of 42 patients without (P = .004). Six deaths occurred in each group (P = .94). The age-adjusted relative risk conferred by stage II hemodynamic failure was 6.0 (95% confidence interval [CI], 1.7-21.6) for all stroke and 7.3 (95% CI, 1.6-33.4) for ipsilateral stroke. CONCLUSIONS Stage II hemodynamic failure defines a subgroup of patients with symptomatic carotid occlusion who are at high risk for subsequent stroke when treated medically. A randomized trial evaluating surgical revascularization in this high-risk subgroup is warranted.