摘要目的 探讨有症状颅内颈内动脉(intracranial internal carotid artery, IICA)狭窄患者的卒中复发风险及其预测因素.方法 前瞻性连续纳入因IICA粥样硬化性狭窄所致首次缺血性卒中或短暂性脑缺血发作(transient ischemic attack, TIA)患者,规律随访入组患者以评估卒中复发情况.结果 共纳入70例患者,男性49例,年龄41~87岁,平均(68.2 ± 12.3)岁,平均随访时间为(34 ± 17)个月(中位数:33个月).27例(38.6%)在随访期间出现复发事件,其中TIA 5例,缺血性卒中22例;92.6%的复发事件出现在原有症状IICA狭窄供血区.卒中复发患者的内分水岭梗死较无卒中复发患者更常见(74.1%对44.2%;P=0.025).Kaplan-Meier生存分析显示,有症状IICA狭窄患者1年、3年和5年的卒中复发风险分别为26.8%、42.5%和46.9%.多变量Cox比例风险回归分析显示,在校正性别、年龄和传统血管危险因素后,有症状IICA狭窄患者卒中复发的预测因素包括糖尿病[风险比(hazard risk, HR)3.68,95%可信区间(confidence interval, CI)1.43~9.46;P=0.007]、合并无症状颅内动脉闭塞性病变(HR 2.95,95% CI 1.16~7.50;P=0.023)和内分水岭梗死(HR 4.50,95% CI 1.43~14.17;P=0.010).结论 有症状IICA狭窄患者在当前药物治疗情况下的长期卒中复发风险仍然较高,糖尿病、合并无症状颅内动脉闭塞性病变和内分水岭梗死与卒中复发关系密切.

abstractsObjective To investigate the risk and predictors of stroke recurrence in patients with symptomatic intracranial internal carotid artery(IICA)stenosis.Methods Consecutive patients with first-ever ischemic stroke or transient ischemic attack (TIA) caused by IICA atherosclerotic stenosis were enrolled prospectively. The patients were regularly followed up to assess stroke recurrence. Results A total of 70 patients were enrolled, 49 patients were males, and the mean age was 68.2 ± 12.3 years. The mean follow-up time was 34 ± 17 months (median, 33 months). Twenty-seven patients (38.6%) experienced recurrent events during the follow-up period (5 TIAs and 22 ischemic strokes);92.6% of recurrent events occurred in the original symptomatic stenotic IICA territory. Internal watershed infarction in patients with recurrent stroke was more common than those without stroke recurrence(74.1% vs. 44.2%,P=0.025). Kaplan-Meier survival analysis showed that the risks of stroke recurrence at 1,3 and 5 years were 26.8%, 42.5%, and 46.9%, respectively in patients with symptomatic IICA stenosis. Multivariate Cox proportional risk regression analysis showed that the predictors for stroke recurrence in patients with symptomatic IICA stenosis included diabetes (hazard risk [HR] 3.68,95% confidence interval[CI] 1.43-9.46; P=0.007), combined asymptomatic intracranial artery occlusive disease(HR 2.95,95% CI 1.16-7.50;P=0.023),and internal watershed infarction (HR 4.50, 95% CI 1.43-14.17; P=0.010) after adjusting for sex, age and traditional vascular risk factors. Conclusions The risk of long-term stroke recurrence in patients with symptomatic IICA stenosis is still high under the current drug treatment. Diabetes, combined asymptomatic intracranial arterial occlusive disease, and internal watershed infarction are closely associated with stroke recurrence.