数字减影全脑血管造影术对缺血性脑卒中复发的影响

Effect of Digital Subtraction Angiography on Ischemic Stroke Recurrence

目的:探讨数字减影全脑血管造影术(Digital subtraction angiography,DSA)对缺血性脑卒中复发(Recurrent Ischemic Stroke,RIS)的影响。方法:将首次经CT或MRI证实的急性缺血性脑卒中并经颈动脉彩超证实存在颈动脉斑块及血管狭窄的患者,随机分为进行DSA的干预组和未行DSA的对照组,随访1年,观察并记录两组患者是否再次出现RIS以及发生的时间。结果:109例入选患者中,除3例因其他系统疾病死亡失访以外,余下的106例(干预组49例,对照组57例)中,共有11例出现RIS,其中干预组RIS再发2例(2/49),对照组RIS再发9例(9/57);11例RIS患者初发至复发的间隔时间为32-315天,平均183.27±98.44天,其中干预组平均270.50±34.65天,对照组平均163.89±98.17天;结果显示行DSA检查的患者1年内RIS的发生率较对照组低(P<0.05),出现脑卒中再发的间隔时间也长于未行DSA检查的患者(P<0.05)。结论:对于存在颈动脉斑块及轻中度狭窄的急性缺血性脑卒中患者,进行DSA检查或可降低其1年内RIS的复发风险,延迟复发出现的时间,DSA在缺血性脑卒中的二级预防中可能具有潜在的预防价值。

Objective To investigate the effect of digital subtraction angiography(DSA) on patients of recurrent ischemic stroke(RIS).Methods Patients,who had got acute ischemic stroke,identified by CT or MRI at his first time,and had carotid plaques and carotid artery stenosis,confirmed by carotid artery Color Dopplar Ultrasound,were divided into two groups randomly according to whether DSA was performed or not: the intervention group and control group.Results and time of RIS in these two groups were investigated and recorded during 1-year follow-up prospectively.Results Besides 3 of 109 total enrolled patients who were lost because of death with other system diseases,11 of the remanent 106 patients got RIS within 1 year.And 2 of them were from intervention group(2/49),9 of them were from control group(9/57).The intervals from occurrence to recurrence of the 11 RIS patients ranged from 32 to 315 days.The average interval time was 183.27±98.44 days in all enrolled patients,and 270.50±34.65 days in intervention group,163.89±98.17 days in control group.The rate of RIS in intervention group was lower than that of in control group(P<0.05),and the intervals of RIS in intervention group was also longer than that of in control group(P<0.05).Conclusion For acute stroke patients who had carotid plaques and carotid artery stenosis,the test of DSA might reduce the recurrence of RIS and extend the intervals of RIS in following 1 year.The test of DSA might have some potential functions for secondary prevention of ischemic stroke recurrence.