Effect of Intracranial Atherosclerosis Burden on the Prognosis of Ischemic Stroke

doi:10.3969/j.issn.1673-5765.2020.04.012

Abstract

Abstract:

Objective To analyze the effect of intracranial atherosclerosis burden (ICASB) on 1-year recurrent stroke in patients with ischemic stroke. Methods A total of 2864 consecutive patients with acute ischemic stroke within 7 days after stroke onset from 22 hospitals across China were included in this analysis. All patients underwent magnetic resonance angiography, and the ICASB was calculated based on the degree and number of intracranial atherosclerotic stenosis. The patients were divided into three groups according to the scores of ICASB: <4, 4-5 and >5 points. Difference in baseline characteristics among the three groups were compared, and the risk factors for recurrent stroke within 1 year were analyzed. Results There were 2491, 214 and 159 cases in ICASB <4 points group, 4-5 points group and >5 points group, respectively. The degrees of culprit artery stenosis were different among the three groups (P <0.0001). The multivariate logistic analysis showed that ICASB 4-5 points (HR 2.28, 95%CI 1.41- 3.71, P =0.0008), family history of stroke (HR 2.06, 95%CI 1.27-3.33, P =0.0033), history of ischemic stroke (HR 2.12, 95%CI 1.29-3.50, P =0.0030), current and prior smoking (HR 0.54, 95%CI 0.35-0.85, P =0.0075) and NIHSS score at admission (HR 1.05, 95%CI 1.00-1.09, P =0.028) were independent risk factors for recurrent stroke within 1 year. Kaplan–Meier curve analysis showed that the rate of recurrent stroke at 1 year was higher in ICASB 4-5 points groups (10.28%) than that in ICASB <4 points group (3.89%) and >5 points group (6.91%) (both P <0.0001). Conclusions The ICASB score 4-5 points was an independent risk factor for recurrent stroke within 1 year in atherosclerotic ischemic stroke.

Key words: Intracranial atherosclerosis burden; Ischemic stroke; Recurrence

摘要：

目的了解颅内动脉粥样硬化负荷（intracranial atherosclerosis burden，ICASB）对缺血性卒中1年复发的影响。方法入组中国22家医院共计2864例发病7 d内的缺血性卒中患者。所有入组患者均进行MRA检查，并根据颅内血管狭窄程度和数量计算ICASB，根据不同的ICASB将患者分为<4分组、4～5分组和>5分组。比较不同ICASB组间基线数据的差异，并分析1年卒中复发的危险因素。结果 ICASB<4分组、4～5分组和>5分组分别有2491例、214例和159例。不同ICASB组责任血管狭窄程度的分布不同，差异有统计学意义（P <0.0001）。多变量分析显示，ICASB 4～5分（HR 2.28， 95%CI 1.41～3.71，P =0.0008）、卒中家族史（HR 2.06，95%CI 1.27～3.33，P =0.0033）、缺血性卒中病史（HR 2.12，95%CI 1.29～3.50，P =0.0030）、以前和现在吸烟史（HR 0.54，95%CI 0.35～0.85， P =0.0075）及入院时NIHSS评分（HR 1.05，95%CI 1.00～1.09，P =0.028）是1年卒中复发的独立危险因素。Kapl an-Meier生存曲线分析显示，ICASB 4～5分组1年卒中复发率（10.28%）较<4分组（3.89%）和 >5分组（6.91%）增高（均P <0.0001）。结论 ICASB 4～5分是缺血性卒中患者1年卒中复发的独立危险因素。

关键词: 颅内动脉粥样硬化负荷; 缺血性卒中; 复发

SUN Ping, NIE Bin, PAN Yue-Song, PU Yue-Hua, MI Dong-Hua, YAN Hong-Yi, GONG Ling, PENG Zhong-Yong, LIU Yuan-Liang, LIU Li-Ping. Effect of Intracranial Atherosclerosis Burden on the Prognosis of Ischemic Stroke[J]. Chinese Journal of Stroke, 2020, 15(04): 394-400.

孙萍，聂斌，潘岳松，濮月华，米东华，严鸿伊，龚玲，彭忠勇，刘远亮，刘丽萍. 颅内动脉粥样硬化负荷对缺血性卒中预后的影响[J]. 中国卒中杂志, 2020, 15(04): 394-400.

References

[1] KIM J S，KIMY J，AHN S H，et al. Location of

cerebral atherosclerosis：why is there a difference

between east and west?[J]. Int J Stroke，2018，13（1）：

35-46.

[2] WANG Y，ZHAO X，LIU L，et al. Prevalence

and outcomes of symptomatic intracranial large

artery stenoses and occlusions in China the Chinese

Intracranial Atherosclerosis（CICAS）Study[J].

Stroke，2014，45（3）：663-669.

[3] BANG O Y. Intracranial atherosclerosis：current

understanding and perspectives[J]. J Stroke，2014，16

（1）：27-35.

[4] SAMANIEGO E A，SHABAN A，ORTEGAGUTIREEEZ

S，et al. Stroke mechanisms and

outcomes of isolated symptomatic basilar artery

stenosis[J]. Stroke Vasc Neuro，2019，4（4），189-

197.

[5] TIAN L，YUE X，XI G，et al. Multiple intracranial

arterial stenosis influences the long-term prognosis

of symptomatic middle cerebral artery occlusion[J].

BMC Neurol，2015，15：68.

[6] SAMUELS O B，JOSEPH G J，LYNN M J，et al.

A standardized method for measuring intracranial

arterial stenosis[J]. AJNR Am J Neuroradiol，2000，

21（4）：643-646.

[7] JEON S B，CHUN S，CHOI-KWON S，et al.

Biomarkers and location of atherosclerosis：matrix

metalloproteinase-2 may be related to intracranial

atherosclerosis[J]. Atherosclerosis，2012，223（2）：

442-447.

[8] SCULLEN T A，MONLEZUN D J，SIEGLER J

E，et al. Cryptogenic stroke：clinical consideration

of a heterogeneous ischemic subtype[J]. J Stroke

Cerebrovasc Dis，2015，24（5）：993-999.

[9] BANERJEE C，CHIMOWITZ M I. Stroke caused by

atherosclerosis of the major intracranial arteries[J].Circ Res，2017，120（3）：502-513.

[10] MATSUI R，NAKAGAWA T，TAKAYOSHI H，et

al. A prospective study of asymptomatic intracranial

atherosclerotic stenosis in neurologically normal

volunteers in a Japanese cohort[J]. Front Neurol，

2016，7：39.

[11] KIM J M，JUNG K H，SOHN C H，et al.

Intracranial plaque enhancement from high

resolution vessel wall magnetic resonance imaging

predicts stroke recurrence[J]. Int J Stroke，2016，11

（2）：171-179.

[12] LAU A Y，WONG K S，LEV M，et al. Burden

of intracranial steno-occlusive lesions on initial

computed tomography angiography predicts poor

outcome in patients with acute stroke[J]. Stroke，

2013，44（5）：1310-1316.

[13] DIELEMAN N，YANG W，ABRIGO J M，et al.

Magnetic resonance imaging of plaque morphology

burden，and distribution in patient with symptomatic

middle cerebral artery stenosis[J]. Stroke，2016，47

（5）：1797-1802.

[14] KIM B S，CHUNG P W，PARK K Y，et al. Burden

of intracranial atherosclerosis is associated with

long-term vascular outcome in patients with

ischemic stroke[J]. Stroke，2017，48（6）：2819-2826.

[15] HOSHINO T，SISSANI L，LABREUCHE J，et al.

Prevalence of systemic atherosclerosis burdens and

overlapping stroke etiologies and their associations

with long-term vascular prognosis in stroke with

intracranial atherosclerotic disease[J]. JAMA Neurol，2018，75（2）：203-211.

[16] ZHANG S，WANG N，CHEN L，et al. Serum

aldosterone is associated with cerebral artery

atherosclerosis and calcification[J]. J Stroke

Cerebrovasc Dis，2019，28（3）：523-530.

[17] RAGHURAM K，DURGAM A，KOHLNHOFER J，

et al. Relationship between stroke recurrence，infarct

pattern，and vascular distribution in patients with

symptomatic intracranial stenosis[J]. J Neurointerv

Surg，2018，10（12）：1161-1163.

[18] LENG X，WONG K S，LIEBESKIND D S.

Evaluating intracranial atherosclerosis rather than

intracranial stenosis[J]. Stroke，2014，45（2）：645-

651.

[19] WONG K S，CAPLAN L R，KIM J S. Stroke

Mechanisms[J]. Front Neurol Neurosci，2016，40：

58-71.

[20] WANG Y，MENG R，LIU G，et al. Intracranial

atherosclerotic disease[J]. Neurobiol Dis，2019，124：

118-132.

[21] LENG X Y，CHEN X Y，CHOOK P，et al.

Correlation of large artery intracranial occlusive

disease with carotid intima-media thickness and

presence of carotid plaque[J]. Stroke，2013，44（1）：

68-72.

[22] SIEGLER J E，MARTIN-SCHILD S. Daily National

Institutes of Health stroke scale examinations at

stroke centers：why not do them?[J]. Int J Stroke，

2015，10（2）：140-142.

[23] MAN B L，FU Y P，CHAN Y Y，et al. Use of

magnetic resonance angiography to predict longterm

outcomes of ischemic stroke patients with

concurrent stenoses in Hong Kong[J]. Cerebrovasc

Dis，2009，28（2）：112-118.