脑血管储备力对症状性大脑中动脉重度狭窄患者卒中风险的预测

Prediction of Cerebrovascular Reserve in Stroke Patients with Severe Symptomatic Unilateral Middle Cerebral Artery Stenosis

目的:研究脑血管储备力(CVR)下降对症状性大脑中动脉(MCA)重度狭窄患者未来发生缺血性卒中风险的预测价值。方法:以DSA判定MCA狭窄程度,应用灌注CT和吸入5%CO_2方法测定CVR,据测定结果分为CVR下降组和CVR正常组,以MCA狭窄同侧的缺血性卒中复发或任何原因的死亡为终点事件,随访12月。结果:CVR正常组30例,无终点事件发生;下降组36例,发生终点事件6例;无死亡病例。本组缺血性事件年发生率为9.09%,CVR正常组和下降组分别为0%和16.67%(P=0.028),CVR下降与狭窄MCA同侧缺血性卒中事件的发生显著相关(Kaplan-Meier Log-rank5.387,P=0.020)。结论:CVR下降预示症状性大脑中动脉重度狭窄患者未来易发生缺血性卒中事件。

Objective： To investigate the usefulness of cerebrovascular reserve （CVR） impairment for predic- tion of ipsilateral ischemic stroke（IS） in patients with I〉 70% symptomatic middle cerebral artery （MCA） steno- sis. Methods： Digital subtraction angiography （DSA） was used to assess the degree of stenosis, and perfusion CT and 5% CO2 inhalation were adopted to evaluate CVR. Patients with/〉70% symptomatic unilateral MCA ste- nosis were assigned to non-CVR impairment group and CVR impairment group according to CVR status. The long-term follow-up endpoint was composite of any IS （in the territory of the studied MCA） or death within 12 months. Results： Sixty-six patients with i〉 70% symptomatic unilateral MCA stenosis, involving 30 non-CVR impairment cases and 36 CVR impairment cases, were included in the present study. Finally, a total of six CVR impairment patients occurred IS, and no endpoint happened in the non-CVR impairment group. Therefore, the annual rate of IS was 16.67% in the CVR impairment group and 0% in the non-CVR impairment group （P=0.028）. Besides, further Kaplan-Meier analysis found CVR impairment was closely associated with the IS risk （Ka-plan-Meier Log-rank 5.387, P=0.020）. Conclusion： For patients with I〉70% symptomatic unilateral MCA ste-nosis, CVR impairment increases the risk of adverse long-term outcomes.