Vertebrobasilar Stenosis Predicts High Early Recurrent Stroke Risk in Posterior Circulation Stroke and TIA
Vertebrobasilar Stenosis Predicts High Early Recurrent Stroke Risk in Posterior Circulation Stroke and TIA
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DOI：
10.1161/strokeaha.109.553859
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发表时间：
2009-08-01
期刊：
影响因子：
8.3
通讯作者：
Markus, Hugh S.
中科院分区：
文献类型：
--
作者：
Gulli, Giosue;Khan, Sofia;Markus, Hugh S.
背景和目的--20%的缺血性卒中发生在后循环，但关于早期卒中复发风险以及椎基底动脉狭窄是否预示高复发风险的前瞻性数据很少。这种自然病史数据很重要，因为在技术上支架植入这种病变是可能的。对比剂增强MRA(CE-MRA)和CT血管成像(CTA)现在可以无创性地识别椎基底动脉狭窄。方法-216名连续的后循环TIA或中风患者被纳入并前瞻性随访90天。排除椎体夹层8例。182例患者在介绍时进行了CE-MRA或CTA检查，并进行了90天的随访。结果：以首次发生的事件(包括前一个月的短暂性脑缺血发作/卒中)为指标，有狭窄的患者再发卒中的风险为30.5%，无狭窄的患者再发卒中的风险为8.9%；RR3.4(95%可信区间1.7~7.0P<；0.001)。以发病为指标病例，RR3.4(95%CI1.1~10.5)，P=0.0274。首次事件后不久复发的可能性最高。结论-椎基底动脉狭窄的存在表明后循环卒中患者具有较高的早期再发卒中风险。早期干预可能会降低中风复发的风险。椎体狭窄现在可以通过支架治疗，但确定这是否可以降低早期中风风险需要随机对照试验。(笔划。2009年；40：2732-2737。)
Background and Purpose-20% of ischemic stroke is in the posterior circulation, but there is little prospective data on early recurrent stroke risk and whether vertebrobasilar stenosis predicts a high recurrence risk. This natural history data are important as it is technically possible to stent such lesions. Contrast enhanced MRA (CE-MRA) and CT angiography (CTA) now allow noninvasive identification of vertebrobasilar stenosis.Methods-216 consecutive patients presenting with posterior circulation TIA or stroke were recruited and prospectively followed for 90 days. 8 patients with vertebral dissection were excluded. CE-MRA or CTA at presentation and 90-day follow-up was available in 182. Any posterior circulation TIA/stroke in the month before the presenting episode was recorded.Results-Taking the first event (including TIA/stroke in the previous month) as the index case recurrent stroke risk in patients with stenosis was 30.5% versus 8.9% in those without; RR 3.4 (95% CI 1.7 to 7.0), P < 0.001). Taking the presenting episode as the index case the risk was 13.8% versus 4.1%; RR 3.4 (95% CI 1.1 to 10.5) P = 0.0274. The probability of recurrence was highest soon after the initial event.Conclusions-The presence of vertebro-basilar stenosis identifies a group of patients with posterior circulation stroke who have a high early recurrent stroke risk. Early intervention might reduce recurrent stroke risk. Vertebral stenosis can now be treated by stenting, but determining whether this reduces the early stoke risk requires randomized controlled trials. (Stroke. 2009; 40: 2732-2737.)