颈内动脉闭塞患者脑缺血事件的随访结果分析

Cerebrovascular ischemic events in patients with internal carotid artery occlusion:an analysis of the follow-up results

目的随访分析颈内动脉闭塞(ICAO)患者脑缺血事件的发生情况。方法回顾性纳入2007年1月至2012年1月于空军总医院神经内科住院连续登记的ICAO患者144例,均经DSA证实为单侧ICAO,并根据患者有无缺血性脑血管病症状分为有症状组(74例)和无症状组(70例)。对两组患者进行随访,随访时间至少2年,观察短暂性脑缺血发作(TIA)及终点事件,如新发症状性脑梗死、任何原因死亡以及侧支循环开放等情况,并比较两组患者间的随访结果。结果有症状组患者新发脑梗死21例(28.4%)、TIA 10例(13.5%)、死亡4例(5.4%),无症状组患者新发脑梗死9例(12.9%)、TIA 4例(5.7%),无死亡病例,有症状组患者卒中复发风险高于无症状组(P=0.025)。Kaplan-Meier曲线显示,有症状组终点事件发生率高于无症状组(χ2=8.428,P=0.004)。有症状组与无症状组间初级侧支循环开放比率差异有统计学意义[64.9%(48/74)比91.4%(64/70),P=0.000];新发脑梗死患者初级侧支循环开放的比例明显低于无新发脑梗死患者[60.0%(18/30)比82.5%(94/114),P=0.013]。结论症状性ICAO更易发生脑梗死,且患者容易死亡;ICAO后初级侧支循环开放对预后有明显影响。

Objective Tofollowupandanalyzetheoccurrenceofcerebrovascularischemiceventsin patientswithinternalcarotidarteryocclusion（ICAO）.Methods Atotalof144consecutivepatients with ICAO admitted to the Department of Neurology,the Air Force General Hospital from January 2007 to January 2012 were enrolled retrospectively. All patients were confirmed as unilateral ICAO with DSA and they were divided into either a symptomatic group （n=74）or an asymptomatic group （n=70）according to whether they had the symptoms of ischemic cerebrovascular disease or not. Both patients of the 2 groups were followed up for at least 2 years. Their transient ischemic attack （TIA）and endpoint events were observed,including new symptomatic cerebral infarction,death from any cause,as well as patency of collateral circulation,andthefollow-upresultsbetweenthetwogroupswerecompared.Results Twenty-one patients （28. 4%）of the symptomatic group had new attack of cerebral infarction,10 cases （13. 5%）had TIA,and 4 cases （5. 4%）died;9 patients （12.9%）of the asymptomatic group had new attack of cerebral infarction,4 cases （5 . 7%）had TIA,and no patients died. Risk of recurrent stroke in patients of the symptomatic group was higher than that of the asymptomatic group （P=0. 025）. Kaplan-Meier curves showed that the incidence of endpoint event of the symptomatic group was higher than that of the asymptomatic group （χ^2 =8. 428,P =0. 004）. There was significant difference in the patent ratio of the primary collateral circulation between the symptomatic group and the asymptomatic group （64. 9%[48/74]＆amp;nbsp;vs. 91. 4%[64/70];P=0. 000）;the patent ratio of the primary collateral circulation in patients with new cerebral infarction was significantly lower than that in patients without new cerebral infarction （60. 0%[18/30]vs.82.5%[94/114];P=0.013）.Conclusion ThepatientswithsymptomaticICAOaremore likely to have cerebral infarction,and they are likely to die. After ICAO,the primary collateral circulation patent has a significant effect on the prognosis.