责任动脉闭塞与夹层相关缺血性卒中复发的相关性分析

doi:10.3969/j.issn.1673-5765.2022.09.004

摘要/Abstract

摘要： 目的寻找脑动脉夹层相关卒中复发的高风险影像学特征，探讨责任动脉闭塞与其复发的关系。
方法前瞻性连续性纳入2018年1月-2022年2月在郑州大学第一附属医院住院的首发脑动脉夹层相关卒中患者，通过MRI、MRA、CTA、HR-MRI及DSA等影像学方法评估血管闭塞、长节段夹层等影像学特征，长期随访其复发情况。通过单因素、多因素COX回归分析其复发的影响因素，构建Kaplan-Meier生存曲线评估血管闭塞与脑动脉夹层相关卒中复发的关系。
结果共纳入107例脑动脉夹层相关卒中患者，有10例（9.3%）患者复发。单因素及多因素COX回归分析提示，责任动脉闭塞是脑动脉夹层相关卒中复发患者预后不良的独立预测因子（HR 6.150，95%CI 1.227～30.810，P=0.027），出血转化也与脑动脉夹层相关卒中复发显著相关（HR 12.605，95%CI 2.373～66.949，P=0.003）。Kaplan-Meier生存曲线提示，闭塞组与非闭塞组卒中复发率差异具有统计学意义（Log-rank P=0.001）。
结论责任动脉闭塞是脑动脉夹层相关卒中复发的危险因素，需要大样本研究进一步验证本研究结果，为二级预防提供更精准的帮助。

文章导读： 本研究前瞻性地纳入107例脑动脉夹层相关卒中患者并进行连续性随访，分析其影像学表现与脑动脉夹层相关卒中复发的关系，结果显示，责任动脉闭塞是脑动脉夹层相关卒中复发的危险因素，有助于为脑动脉夹层相关卒中的治疗及二级预防提供更精准的帮助。

关键词: 脑动脉夹层; 缺血性卒中; 复发; 危险因素; 血管闭塞

Abstract: Objective To investigate the relationship between culprit cerebral artery occlusion and cerebral artery dissection (CAD)-related stroke recurrence.
Methods The patients with first CAD-related ischemic stroke who were admitted in the First Affiliated Hospital of Zhengzhou University from January 2018 to February 2022 were prospectively included in this study. CTA, MRA, HR-MRI, DSA and other imaging methods were used to evaluate the imaging characteristics of culprit cerebral artery occlusion and long-segment dissection; and the long-term imaging follow-up was performed to evaluate stroke recurrence. COX regression analysis was used to evaluate the risk factors of stroke recurrence, and Kaplan-Meier survival curve was constructed to evaluate the relationship between cerebral artery occlusion and CAD-related stroke recurrence.
Results A total of 107 cases were included in the analysis, with stroke recurrence in 10 patients (9.7%). Cox regression analysis showed that culprit artery occlusion (HR 6.150, 95%CI 1.227-30.810, P=0.027) and hemorrhagic transformation (HR 12.605, 95%CI 2.373-66.949, P=0.003) were independent risk factors of CAD-related stroke recurrence. The Kaplan-Meier survival curve showed that there was statistical difference in stroke recurrence between artery occlusion and non-occlusion groups (Log-rank P=0.001).
Conclusions Artery occlusion is a risk factor of CAD-related stroke recurrence.

Key words: Cerebral artery dissection; Ischemic stroke; Recurrence; Risk factor; Artery occlusion

张一歌, 张婉, 张璐阳, 王鑫, 丁澜, 王玉莹, 裴璐璐, 方慧, 许予明, 宋波. 责任动脉闭塞与夹层相关缺血性卒中复发的相关性分析[J]. 中国卒中杂志, 2022, 17(09): 932-936.

ZHANG Yige, ZHANG Wan, ZHANG Luyang, WANG Xin, DING Lan, WANG Yuying, PEI Lulu, FANG Hui, XU Yuming, SONG Bo. Association of Artery Occlusion and Recurrent Ischemic Stroke Related with Cerebral Artery Dissection [J]. Chinese Journal of Stroke, 2022, 17(09): 932-936.

参考文献

[1] ZHU Z，XU Y Y，WANG Y L，et al. Chinese cervicocephalic artery dissection study（CCADS）：rationale and protocol for a multicenter prospective cohort study[J/OL]. BMC Neurol，2018，18（1）：6[2022-07-15]. https://doi.org/10.1186/s12883-018-1011-x.
[2] KLOSS M，GROND-GINSBACH C，RINGLEB P，et al. Recurrence of cervical artery dissection：an underestimated risk[J/OL]. Neurology，2018，90（16）：e1372-e1378[2022-07-15]. https://doi.org/10.1212/WNL.0000000000005324.
[3] SERKIN Z，LE S，SILA C. Treatment of extracranial arterial dissection：the roles of antiplatelet agents，anticoagulants，and stenting[J/OL]. Curr Treat Options Neurol，2019，21（10）：48[2022-07-15]. https://doi.org/10.1007/s11940-019-0589-7.
[4] ENGELTER S T，TRAENKA C，LYRER P. Dissection of cervical and cerebral arteries[J/OL]. Curr Neurol Neurosci Rep，2017，17（8）：59[2022-07-15]. https://doi.org/10.1007/s11910-017-0769-3.
[5] MARKUS H S，LEVI C，KING A，et al. Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection：the cervical artery dissection in stroke study（CADISS）randomized clinical trial final results[J]. JAMA Neurol，2019，76（6）：657-664.
[6] Stroke--1989. Recommendations on stroke prevention，diagnosis，and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders[J]. Stroke，1989，20（10）：1407-1431.
[7] SPORNS P B，NIEDERSTADT T，HEINDEL W，et al. Imaging of spontaneous and traumatic cervical artery dissection：comparison of typical CT angiographic features[J]. Clin Neuroradiol，2019，29（2）：269-275.
[8] EKKER M S，BOOT E M，SINGHAL A B，et al. Epidemiology，aetiology，and management of ischaemic stroke in young adults[J]. Lancet Neurol，2018，17（9）：790-801.
[9] ENGELTER S T，GROND-GINSBACH C，METSO T M，et al. Cervical artery dissection：trauma and other potential mechanical trigger events[J]. Neurology，2013，80（21）：1950-1957.
[10] NORRIS J W，BELETSKY V. Cervical arterial dissection[J/OL]. Adv Neurol，2003，92：119-125[2022-07-15]. https://pubmed.ncbi.nlm.nih.gov/12760173/.
[11] DEBETTE S. Pathophysiology and risk factors of cervical artery dissection：what have we learnt from large hospital-based cohorts?[J]. Curr Opin Neurol，2014，27（1）：20-28.
[12] FRAGOSO Y D，ADONI T，DO AMARAL L L，et al. Cerebrum-cervical arterial dissection in adults during sports and recreation[J]. Arq Neuropsiquiatr，2016，74（4）：275-279.
[13] ROSATI L M，VEZZETTI A，REDD K T，et al. Early anticoagulation or antiplatelet therapy is critical in craniocervical artery dissection：results from the COMPASS registry[J]. Cerebrovasc Dis，2020，49（4）：369-374.
[14] NTAIOS G，LAMBROU D，CUENDET D，et al. Early major worsening in ischemic stroke：predictors and outcome[J]. Neurocrit Care，2013，19（3）：287-292.
[15] HONIG A，PERCY J，SEPEHRY A A，et al. Hemorrhagic transformation in acute ischemic stroke：a quantitative systematic review[J/OL]. J Clin Med，2022，11（5）：1162[2022-07-15]. https://doi.org/10.3390/jcm11051162.
[16] KIM B M，KIM S H，KIM D I，et al. Outcomes and prognostic factors of intracranial unruptured vertebrobasilar artery dissection[J]. Neurology，2011，76（20）：1735-1741.
[17] SIKKEMA T，UYTTENBOOGAART M，VAN DIJK J M，et al. Clinical features and prognosis of intracranial artery dissection[J]. Neurosurgery，2015，76（6）：663-671.
[18] TRAENKA C，GROND-GINSBACH C，GOEGGEL SIMONETTI B，et al. Artery occlusion independently predicts unfavorable outcome in cervical artery dissection[J/OL]. Neurology，2020，94（2）：e170-e180[2022-07-15]. https://doi.org/10.1212/WNL.0000000000008654.
[19] METSO T M，METSO A J，SALONEN O，et al. Adult cervicocerebral artery dissection：a single-center study of 301 finnish patients[J]. Eur J Neurol，2009，16（6）：656-661.
[20] DEBETTE S，COMPTER A，LABEYRIE M A，et al. Epidemiology，pathophysiology，diagnosis，and management of intracranial artery dissection[J]. Lancet Neurol，2015，14（6）：640-654.