急性缺血性卒中患者大脑中动脉狭窄微栓子信号预测再发脑缺血事件

Microembolic Signal Predicts Recurrent Cerebral Ischemic Events in Acute Stroke Patients With Middle Cerebral Artery Stenosis

本文是采用经颅多普勒超声(TCD)检测大脑中动脉狭窄(MCA)微栓子信号(MES)的研究,选择了114例MCA狭窄的急性缺血性卒中患者,结果发现22%的患者有MES,平均18个(1～102),重度狭窄(48%)患者较轻中度狭窄者(15%)更易出现MES。平均随访13．6个月(1～32个月),其中12例(12．2%)患者再次出现MCA供血区域的缺血事件(10例卒中,2例TIA)。Cox回归分析显示调整其他卒中高危因素后,MES是再发缺血性卒中/TIA的独立预测因子(P=0．01)。检测MES能够预测MCA狭窄的急性卒中患者脑缺血的复发,因此提出应将MES检测作为常规检查的一部分,这或许能识别那些最可能从抗栓治疗中获益的患者。

This study was for the mocroembolic signal(MES)detection with transcranial Doppler(TCD)in acute stroke patients with middle cerebral artery(MCA)stenosis.Atotal of 114 consecutive patients were studied.MES was detected in 22% of the patients.The mean number of MES was 18(range,1-102).MES were more common in patients with severe stenosis(48%)than in those with mild-moderate stenosis(15%).During follow-up with a mean of 13.6 months(range,1 -32),12(12.2%)patients had further ischemic events(10 strokes and 2 YIAs)in the affected MCA region during follow- up.The presence of MES was the only predictor of a further ischemic stroke/TIA by Cox regression(adjusted odds ratio,8.45; 95% CI,1.69 to 42.22;P=0.01)even after controlling for age,sex,diabetes,hypertension,previous stroke,smoking, and acute treatment.It is concluded that in acute stroke patients with MCA stenosis,MES predicts further cerebral ischemia. This procedure should be considered as part of routine investigation and might identify a group of patients who are most likely to benefit from antithrombotic treatment.