Zhongguo cuzhong zazhi (Jun 2024)
颅内动脉与颈动脉并存斑块分布特征对缺血性卒中复发风险的预测价值研究 Study on the Predictive Value of the Intracranial and Carotid Arteries Coexisting Atherosclerotic Plaque Distribution Characteristics for the Risk of Ischemic Stroke Recurrence
Abstract
目的 探讨颅内动脉与颈动脉并存斑块分布特征对卒中复发风险的预测价值。 方法 连续纳入2周内发生缺血性卒中且至少一侧颈动脉存在粥样硬化斑块的患者，于基线期进行颅外颈动脉多对比度MR血管壁成像和颅内动脉MRA检查。随后对所有患者进行至少1年的随访研究，观察有无缺血性卒中复发。分析粥样硬化斑块在颅外颈动脉不同节段的分布特征，以及前循环颅内动脉狭窄并存颅外颈动脉不同节段斑块的发生率。采用Cox回归计算前循环颅内动脉狭窄并存颈动脉不同节段斑块对缺血性卒中复发的预测价值。 结果 共纳入117例患者，平均年龄为（62.6±11.8）岁，其中男性85例，中位随访时间为12.0（11.1～12.8）个月，有31例（26.5%）患者发生缺血性卒中复发。前循环颅内动脉狭窄并存颈动脉球部斑块与卒中复发显著相关（HR 2.535，95%CI 1.085～5.922，P=0.032），校正年龄、性别、BMI混杂因素后该相关性仍具有统计学意义（HR 2.903，95%CI 1.114～7.565，P=0.029）。前循环颅内动脉狭窄并存颈动脉其他节段斑块与卒中复发无相关（P>0.05）。 结论 在缺血性卒中且至少一侧颈动脉存在粥样硬化斑块的患者中，前循环颅内动脉狭窄并存颈动脉球部斑块与卒中复发独立相关。 Abstract: Objective To investigate the predictive value of intracranial and carotid arteries coexisting atherosclerotic plaque distribution characteristics for the risk of stroke recurrence. Methods Patients with ischemic stroke within 2 weeks and at least one carotid plaque were consecutively included and underwent multi-contrast MR vessel wall imaging for extracranial carotid arteries and MRA for intracranial arteries at baseline. All patients were followed up for at least 1 year to record stroke recurrence. The distribution characteristics of atherosclerotic plaque in different segments of the extracranial carotid artery and the incidence of coexisting intracranial artery stenosis in anterior circulation and extracranial carotid artery atherosclerotic plaques in different segments were analyzed. Univariate and multivariate Cox regressions were used to calculate the predictive value of coexisting intracranial artery stenosis in anterior circulation and carotid artery atherosclerotic plaques in different segments for stroke recurrence. Results A total of 117 patients were included, with a mean age of (62.6±11.8) years, including 85 males. The median follow-up time was 12.0(11.1-12.8) months, and 31(26.5%) patients experienced stroke recurrence. Coexisting intracranial artery stenosis in the anterior circulation and atherosclerotic plaques in the segment of the carotid bulb was significantly associated with stroke recurrence (HR 2.535, 95%CI 1.085-5.922, P=0.032). After adjusting for confounding factors (age, sex, and BMI), this association remained statistically significant (HR 2.903, 95%CI 1.114-7.565, P=0.029). No significant association was found between intracranial artery stenosis in anterior circulation coexistent with atherosclerotic plaque in other segments of the carotid artery and stroke recurrence (P>0.05). Conclusions In patients with ischemic stroke and at least one carotid plaque, coexisting intracranial artery stenosis in anterior circulation and atherosclerotic plaque in the segment of the carotid bulb was independently associated with stroke recurrence.
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