症状性单纯大脑中动脉狭窄患者卒中复发和临床预后及血管改变的随访分析

Symptomatic middle cerebral artery stenosis: stroke recurrence,clinical prognosis and vascular change

目的观察症状性单纯大脑中动脉(MCA)狭窄患者首次急性缺血性卒中后的卒中复发、临床预后及血管动态改变情况。方法前瞻性、连续纳入症状性单纯MCA狭窄首次急性缺血性卒中患者的临床资料及血管影像资料,并进行为期6个月的随访,观察患者神经缺损程度、同侧卒中复发及血管动态改变情况。结果共纳入80例患者,其中16例(20.0%)随访期出现同侧缺血性卒中复发,56例(70.0%)6个月后神经功能恢复良好(改良Rankin量表评分≤1);70例完成脑血管评估的患者中,27例(38.6%)随访期出现血管狭窄程度的动态改变,其中进展12例(17.1%),缓解15例(21.4%)。结论症状性单纯MCA狭窄患者首次缺血性卒中后有较高的同侧缺血性卒中复发风险,但相对临床神经功能恢复良好;首次缺血性卒中后6个月内大部分患者血管状态稳定,但有部分患者可出现血管狭窄的进展或缓解。

objective To investigate the recurrence of stroke, clinical prognosis and vascular changes in patients with ischemic stroke due to middle cerebral artery stenosis. Methods The ischemie stroke patients with symptomatic middle cerebral artery stenosis were enrolled continuously and followed up prospectively for six months. The recurrence of ipsilateral stroke, clinical prognosis and dynamic changes of vessels were analyzed. Results Eighty patients were included,and 20. 0% of the patients（ 16 cases ） presented with recurrence of ipsilateral ischemic stroke and 56 cases （70. 0% ） with a good outcome（modified Rankin scale [ nRS ] ≤ 1 ） during the 6 months follow-up ; 38.6% patients （ 27 cases） presented with significant vascular changes with progression in 12 cases （17. 1% ） and regression in 15 cases （21.4%） . Conclusion The patients with simple symptomatic middle cerebral artery stenosis have an high rate recurrence of ipsilateral stroke but have good prognosis ; Lesioned artery of the majority of patients in the short period after stroke was stable, but vascular stenosis in some patients could appear progression or remission.