Relationship between stroke recurrence, infarct pattern, and vascular distribution in patients with symptomatic intracranial stenosis
Relationship between stroke recurrence, infarct pattern, and vascular distribution in patients with symptomatic intracranial stenosis
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DOI：
10.1136/neurintsurg-2017-013735
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发表时间：
2018-12-01
影响因子：
4.8
通讯作者：
Singh, Ayush
中科院分区：
文献类型：
--
作者：
Raghuram, Karthikram;Durgam, Aditya;Singh, Ayush
目的鉴于最近的文献提示卒中复发和介入相关风险可能与斑块生理学/不稳定性相关，我们的研究试图识别卒中模式和斯托克复发率，因为它们与潜在狭窄的解剖结构和表现有关。方法对卒中数据库中的患者进行回顾性病历以及CT和MR血管造影检查，包括患者危险因素的识别、药物治疗优化、依从性、血清胆固醇（低密度脂蛋白）水平、血压、物理治疗转诊、随访临床状态（使用改良兰金量表）和卒中复发率。39例患者符合入选标准。我们评估了梗死类型（栓塞、邻近交通支或分水岭）和血管分布。结果基底动脉狭窄最可能表现为穿支性卒中，复发率最低。出院时接受次优药物治疗的患者复发卒中的可能性是正常患者的两倍。在优化药物治疗的患者中，栓塞性梗死模式的患者没有复发卒中，而分水岭梗死模式的患者复发率为57%。结论：我们的研究结果表明，血流动力学颅内血管狭窄可能对药物治疗反应较低，而斑块不稳定或交通支区域引起的狭窄病变可能受益于延迟或分期血管内治疗的积极药物治疗。卒中复发可能受血管分布和积极的风险因素控制的影响，尽管后者仍然难以评估。
Objective In view of recent literature suggesting that stroke recurrence and risks related to intervention may be related to plaque physiology/instability, our study sought to discern the pattern of stroke and rates of stoke recurrence as they relate to the anatomy and presentation of the underlying stenosis. Methods Retrospective chart as well as CT and MR angiographic imaging review of patients in the institutional stroke database was performed, including identification of patient risk factors, medical therapeutic optimization, compliance, serum cholesterol (low density lipoprotein) levels, blood pressure, physical therapy referrals, follow-up clinical status (using the modified Rankin Scales), and rate of recurrent stroke. 39 patients met the inclusion criteria. We evaluated infarct pattern (embolic, adjacent perforator, or watershed) and vascular distribution. Results Basilar artery stenosis was most likely to present as a perforator stroke and least likely to recur. Patients discharged with suboptimal medical therapy were twice as likely to have a recurrent stroke. Among patients with optimized medical therapy, no recurrent strokes were seen in patients with an embolic infarct pattern, while a 57% recurrence rate was seen in patients with a watershed infarct pattern. Conclusions Our results suggest that hemodynamic intracranial vascular stenoses may be less responsive to medical therapy, while stenotic lesions caused by plaque destabilization or in perforator territories may benefit from aggressive medical management with delayed or staged endovascular therapy. Recurrence of stroke may be affected both by vascular territory and by aggressive risk factor control, although the latter remains difficult to evaluate.