Risk factors and outcome of patients with symptomatic intracranial stenosis presenting with lacunar stroke.
Risk factors and outcome of patients with symptomatic intracranial stenosis presenting with lacunar stroke.
复制标题
DOI：
10.1161/strokeaha.111.641696
复制
发表时间：
2012-05
期刊：
影响因子：
8.3
通讯作者：
Warfarin Aspirin Symptomatic Intracranial Disease (WASID) Trial Investigators
中科院分区：
文献类型：
--
作者：
Khan A;Kasner SE;Lynn MJ;Chimowitz MI;Warfarin Aspirin Symptomatic Intracranial Disease (WASID) Trial Investigators
我们假设颅内狭窄伴腔隙性卒中的患者复发性卒中的风险低于指数非腔隙性卒中患者，并且他们的复发性卒中主要是腔隙性卒中。我们分析了参加华法林阿司匹林症状性颅内疾病（WASID）试验的指数中风受试者。索引卒中被分类为腔隙性或非腔隙性。主要终点是复发性缺血性卒中。生成考克斯比例风险模型，并对狭窄严重程度进行分层。347例受试者在索引卒中后入组，38例为腔隙性，309例为非腔隙性。平均随访1.8年，腔隙性卒中（7/38; 18%）与非腔隙性卒中（69/309; 22%）患者的卒中复发率无显著差异（HR 0.79，95%CI：0.36-1.71）。此外，当按50-69%狭窄（HR 0.50，95%CI：0.12-2.1）和≥70%狭窄（HR 0.87，95%CI：0.34-2.2）分层时，未发现显著差异。7例复发性卒中患者的指标卒中为腔隙性卒中，所有7例均为非腔隙性卒中，3例位于狭窄动脉范围内。在有症状的颅内狭窄患者中，出现腔隙性和非腔隙性卒中的患者复发性卒中的风险相似，出现腔隙性卒中的患者复发性卒中通常为非腔隙性。这些结果表明，这些中风的病理生理学是与狭窄，而不是小血管疾病。出现腔隙性卒中的患者应纳入研究症状性颅内狭窄二级预防的试验。
We hypothesized that patients with intracranial stenosis with lacunar stroke presentations would face lower risks of recurrent stroke than those with index non-lacunar strokes, and that their recurrent strokes would predominantly be lacunar. We analyzed subjects enrolled with an index stroke into the Warfarin Aspirin Symptomatic Intracranial Disease (WASID) trial. The index stroke was classified as lacunar or non-lacunar. The primary endpoint was recurrent ischemic stroke. Cox proportional hazard models were generated with stratification for severity of stenosis. 347 subjects were enrolled after an index stroke, 38 were lacunar and 309 were non-lacunar. Over a mean follow-up of 1.8 years there was no significant difference in stroke recurrence between patients whose index stroke was lacunar (7/38; 18%) vs. non-lacunar (69/309; 22%) (HR 0.79, 95%CI:0.36–1.71). Further, no significant differences were found when groups were stratified by 50–69% stenosis (HR 0.50, 95%CI:0.12–2.1) and ≥70% stenosis (HR 0.87, 95%CI:0.34–2.2). Of the 7 recurrent strokes in patients whose index stroke was lacunar, all 7 were non-lacunar and 3 were in the territory of the stenotic artery. In patients with symptomatic intracranial stenosis, the risk of recurrent stroke was similar in patients who presented with lacunar and non-lacunar strokes, and recurrent strokes in patients presenting with lacunar stroke were typically non-lacunar. These findings suggest that the pathophysiology of these strokes is related to the stenosis rather than small vessel disease. Patients presenting with lacunar strokes should be included in trials investigating secondary prevention for symptomatic intracranial stenosis.