青年颅内外动脉狭窄患者的危险因素和治疗方式与不良预后的关系

Correlation of risk factors and therapeutic options with the unfavorable results in young patients with intra-and extracranial artery stenosis

目的探讨青年颅外和(或)颅内动脉中、重度狭窄患者复发或死亡与卒中危险因素及不同治疗方式的关系。方法回顾性分析62例经全脑血管造影(DSA)证实有颅外和(或)颅内动脉中、重度狭窄患者的临床资料,其中脑梗死42例,短暂性脑缺血发作(TIA)20例;选择药物治疗39例,血管内治疗23例。采集患者既往史(包括心肌梗死、脑梗死、高血压病等)、个人史(包括吸烟、饮酒等)、血管病家族史及血三酰甘油等生化指标。电话随访终点事件(复发或死亡)的发生情况。平均随访(35±19)个月。结果DSA结果显示,颅外动脉中、重度狭窄17例(27.4%),颅内动脉中、重度狭窄52例(83.9%,P=0.000,其中7例颅内、外动脉均有狭窄)。卒中复发6例,死亡3例,终点事件发生率为14.5%。复发或死亡发生在药物治疗的患者中8例(8/39,20.5%)、血管内治疗患者1例(1/23,4.3%,P=0.170)。两种治疗方式对终点事件的影响差异无统计学意义,但血管内治疗有优于药物治疗的趋势。Logistic回归分析显示,高血压病史(OR=12.107,P=0.005)和治疗方式(OR=0.069,P=0.026)是终点事件重要的影响因素。结论青年颅内动脉狭窄率(尤其M1段)远高于颅外动脉。对有中、重度动脉狭窄的青年患者采用血管内治疗是积极的选择。

Objective To explorer the correlation of end results with the risk factors and therapeutic options in ischemic stroked young patients with moderate or high-grade extraor intracranial artery stenosis. Methods Sixty-two young ischemic stroked patients were retrospectively evaluated. The artery stenosis were demonstrated by conventional cerebral angiography. A total of 42 patients （ 67.7% ） were diagnosed as cerebral infarction and 20 （32.3%） were transient ischemic attack. The medical history （including myocardial infarction, cerebral infarction, and hypertension）, personal history （ including smoking, and alcoholic consumption） and the family history of angiopathy in all patients were collected. Their serum triacylglycerol, total cholesterol, high-density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A1, apolipoprotein B, hematocrit, fibrinogen and homocysteic acid were measured. The conventional angiography for aortic arch and four-vessel cerebral arteries was performed. The patients with moderate or high-grade extraor intracranial artery stenosis were treated with selected medicines（ aspirin etc. ） or endovascular intervention （stent placement or balloon dilation angioplasty alone） according to their vascular conditions and patients＇ willingness. The end results of the patients were followed-up by telephone inquiry. Results The mean follow-up period was 35.0± 19.0 months. The recurrence of stroke occurred in 6 patients, and 3 patients died. The incidence of unfavorable end result was 14.5%. The angiographic findings demonstrated that moderate- or high-grade stenostic rate in the intracranial arteries （83.9%） was significantly higher than in extracranial arteries （27.4%, P = 0. 000 ）. Eight patients （20.5%） had unfavorable end-results in the medical treatment group and 1 （4.3%, P =0. 170） in the endovascular treatment group. However, there was a trend suggesting that the result of endovascular treatment group was superior to the medical treatment group. Multi-factors logistic regression analysis showed that hypertension （ OR = 12. 107, P =0.005） and the therapeutic method（OR = 0.069, P =0.026） were the significant factors. Conclusions Moderate- or high-grade of intracranial arteries （especially in middle cerebral artery M1 segment） stenosis in young ischemic stroke patients is much common than the extracranial arteries. Endovascular intervention is an aggressive choice for treatment of these patients.