Autopsy prevalence of intracranial atherosclerosis in patients with fatal stroke
Autopsy prevalence of intracranial atherosclerosis in patients with fatal stroke
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DOI：
10.1161/strokeaha.107.496513
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发表时间：
2008-04-01
期刊：
影响因子：
8.3
通讯作者：
Amarenco, Pierre
中科院分区：
文献类型：
--
作者：
Mazighi, Mikael;Labreuche, Julien;Amarenco, Pierre
背景和目的-本研究的目的是确定颅内斑块和狭窄的患病率及其在致死性卒中患者中的因果关系。颅内动脉粥样硬化被认为是一种罕见的疾病，预后严重。然而，疾病的患病率可能会被低估，由于缺乏适当的诊断programmes.Methods -我们进行了系统的分析，颅内和颅外动脉，主动脉弓，心脏在339例连续尸检中风患者。分析了临床病史、危险因素、影像学资料和一般尸检报告。脑出血患者（n = 80）作为对照组。（95% CI，56.3 - 68.1）和43.2%脑梗死患者的95%CI分别为37.2至49.3，而脑出血患者的95%CI分别为48.8%（P < 0.05）和17.5%（P < 0.001）。在43%的脑梗死患者中，至少有一个颅内斑块诱导的管腔狭窄分级> 30%，5.8%的病例（n = 15）的狭窄被认为是因果关系，因为溃疡斑块上叠加了凝块;这些患者中有27%的狭窄分级为30%至75%。在多变量分析中，糖尿病和男性与颅内斑块和狭窄显著相关。心肌梗死史与颅内斑块显著相关，既往卒中与颅内狭窄相关。结论-颅内斑块和狭窄在致死性卒中中非常普遍，30%至75%的狭窄可能是病因。应采用新的动脉壁成像技术来重新评估脑卒中患者颅内动脉斑块的发生频率和作用。
Background and Purpose - The objective of this study was to determine the prevalence of intracranial plaques and stenoses and their causal role in patients with fatal stroke. Intracranial atherosclerosis is considered to be a rare condition with a severe prognosis. However, disease prevalence may be underestimated due to lack of appropriate diagnostic procedures.Methods - We performed a systematic analysis of intra-and extracranial arteries, the aortic arch, and the heart in 339 consecutive autopsies of patients with stroke. Clinical history, risk factors, imaging data, and general autopsy reports were analyzed. Patients with brain hemorrhage (n = 80) were used as control subjects.Results - Intracranial plaques and stenoses occurred in 62.2% (95% CI, 56.3 to 68.1) and 43.2% (95% CI, 37.2 to 49.3) of patients with brain infarction, respectively, compared with 48.8% (P < 0.05) and 17.5% (P < 0.001) of patients with brain hemorrhage, respectively. In the 43% of patients with brain infarction with at least one intracranial plaque-inducing luminal stenosis graded > 30%, the stenosis was considered to be causal in 5.8% of cases (n = 15) because of superimposed clot on ulcerated plaques; 27% of these patients had stenoses graded 30% to 75%. In multivariate analyses, diabetes and male sex were significantly associated with intracranial plaques and stenosis. History of myocardial infarction was significantly associated with intracranial plaques and previous stroke was associated with intracranial stenosis.Conclusions - Intracranial plaques and stenoses are highly prevalent in fatal stroke, and stenoses graded 30% to 75% may be causal. New arterial wall imaging techniques should be used to reevaluate the frequency and role of intracranial artery plaques in living patients with stroke.