Dissection of cervical arteries:: Long-term follow-up study of 130 consecutive cases
Dissection of cervical arteries:: Long-term follow-up study of 130 consecutive cases
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DOI：
10.1159/000093244
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发表时间：
2006-01-01
影响因子：
2.9
通讯作者：
Roman, Gustavo
中科院分区：
文献类型：
--
作者：
Arauz, Antonio;Hoyos, Leticia;Roman, Gustavo
背景和目的：我们在一项连续的观察性研究中描述了颈动脉夹层（DCA）患者的自然病史、功能预后和长期复发情况。研究方法：我们描述了130例经血管造影证实的DCA患者入住墨西哥城（墨西哥）神经病学研究所，并分析了临床和神经影像学数据、治疗和结局。由主治医生决定抗凝或阿司匹林治疗。主要结局指标为6个月时的复发（卒中和死亡）和临床结局。进行随访研究以确定再通。结果如下：平均年龄为35.4岁; 4例患者死亡（3%），126例患者随访3，906人/年; 17例患者（13%）在诊断DCA前约8天发生了预示性缺血性脑事件（6例卒中，11例TIAS）。诊断后，6例患者（4.8%）在前2周内发生复发性缺血性卒中（1.5人/1，000随访年）。阿司匹林和抗凝治疗之间无显著差异。再通在椎体夹层中更常见。椎体夹层完全再通与良好预后相关[OR 3.2（95% CI 1.1 - 8.8; p = 0.02）]。结论：在墨西哥，DCA影响年轻人，并可能出现预示性卒中或TIA。我们发现了罕见的早期缺血性复发。椎动脉夹层的预后较颈动脉夹层好，尤其是在完全再通的患者中。版权所有（c）2006 S. Karger AG，巴塞尔
Background and Purpose: We describe the natural history, functional prognosis and long-term recurrences of patients with dissection of cervical arteries ( DCA) in a sequential observational study. Methods: We describe 130 patients with angiographically- proven DCA admitted to the Neurology Institute in Mexico City ( Mexico), and analyzed clinical and neuroimaging data, treatment and outcome. Treatment with either anticoagulation or aspirin was decided by the primary physician. Primary outcome measures were recurrence ( stroke and death) and clinical outcome at 6 months. Follow-up studies were performed to determine recanalization. Results: Mean age was 35.4 years; 4 patients died ( 3%) and 126 were followed for 3,906 person/ years; 17 patients ( 13%) had a heralding ischemic cerebral event ( 6 strokes, 11 TIAS) about 8 days before the diagnosis of DCA. After diagnosis, recurrent ischemic stroke occurred in 6 patients ( 4.8%) within the 2 first weeks ( 1.5 persons/ 1,000 follow-up years). No significant differences were found between aspirin and anticoagulation. Recanalization was more frequent in vertebral dissections. Complete recanalization of vertebral dissections was associated with a favorable prognosis [ OR 3.2 ( 95% CI 1.1 - 8.8; p = 0.02)]. Conclusions: In Mexico, DCA affects young adults and may present with a heralding stroke or TIA. We found rare, early ischemic recurrences. Vertebral territory dissections had better prognosis than carotid ones, particularly in patients with demonstrated complete recanalization. Copyright (c) 2006 S. Karger AG, Basel