Angiographically defined collateral circulation and risk of stroke in patients with severe carotid artery stenosis
Angiographically defined collateral circulation and risk of stroke in patients with severe carotid artery stenosis
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DOI：
10.1161/01.str.31.1.128
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发表时间：
2000-01-01
期刊：
影响因子：
8.3
通讯作者：
Barnett, HJM
中科院分区：
文献类型：
--
作者：
Henderson, RD;Eliasziw, M;Barnett, HJM
背景和目的--侧支通路供血可改善局部脑血流量，对缺血事件有保护作用。在存在严重的颈内动脉(ICA)狭窄的情况下，评估侧支血管对卒中和短暂性脑缺血发作(TIA)风险的影响。方法：所有患者在进入北美症状性颈动脉内膜切除术试验时，通过前交通动脉和后交通动脉进行侧支循环充盈，通过眼动脉进行逆行充盈。对339名接受内科治疗的患者和342名接受手术治疗的患者进行了Kaplan-Meier事件-预后分析。结果：供应症状性颈内动脉的侧支的存在随着狭窄的严重程度而增加。在有侧支存在的情况下，接受药物治疗的严重颈内动脉狭窄患者发生半球中风的两年风险从27.8%降至11.3%(P=0.005)。大脑半球短暂性脑缺血发作(36.1%比19.1%；P=0.008)和致残性或致命性卒中(13.3%比6.3%；P=0.11)也有类似的下降。对于接受手术治疗的患者，在有侧支存在的情况下，围手术期发生半球卒中的风险为1.1%，而在没有侧支存在的情况下，发生半球卒中的风险为4.9%。有侧支和无侧支的外科患者2年的卒中风险分别为5.9%和8.4%。手术组的这两项比较在统计学上均无统计学意义。观察到的减少与颈内动脉狭窄程度和其他血管危险因素无关。结论：侧支循环与大脑半球卒中和TIA的风险较低，无论是长期还是围手术期都是如此。侧支血管造影有助于识别中风和短暂性脑缺血发作风险较低的严重颈内动脉狭窄患者。
Background and Purpose-Blood supply through collateral pathways improves regional cerebral blood flow and may protect against ischemic events. The effect of collaterals on the risk of stroke and transient ischemic attack (TIA), in the presence of angiographic severe internal carotid artery (ICA) stenosis, was assessed.Methods-Angiographic collateral filling through anterior communicating and posterior communicating arteries and retrograde filling through ophthalmic arteries were determined in all patients at entry into the North American Symptomatic Carotid Endarterectomy Trial. Kaplan-Meier event-foe survival analyses were performed on 339 medically treated and 342 surgically treated patients.Results-The presence of collaterals supplying the symptomatic ICA increased with severity of stenosis. Two-year risk of hemispheric stroke in medically treated patients with severe ICA stenosis was reduced in the presence of collaterals: 27.8% to 11.3% (P=0.005). Similar reductions were observed for hemispheric TIA (36.1% versus 19.1%; P=0.008) and disabling or fatal strokes (13.3% versus 6.3%; P=0.11). For surgically treated patients, the perioperative risk of hemispheric stroke was 1.1% in the presence of collaterals versus 4.9% when absent. The 2-year stroke risks for surgical patients with and without collaterals were 5.9% versus 8.4%, respectively. Neither comparison in the surgical group was statistically significant. The observed reductions were independent of the degree of ICA stenosis and other vascular risk factors.Conclusions-Collaterals are associated with a lower risk of hemispheric stroke and TIA, both long term and perioperatively. Angiographic identification of collaterals assists in identifying patients with severe ICA stenosis at lower risk of stroke and TIA.