关注症状性颅内动脉狭窄20120812.ppt

缺血性脑血管病患者脑动脉狭窄特征 527例国内脑梗死/TIA (2004-2005) DSA:主动脉弓+锁骨下动脉+全脑 好发部位：颅内-MCA, ICA颅内段; 颅外-ICA/VA起始部 中年(41-60岁)和老年(60岁)以合并颅内外动脉狭窄为最高 美国AHA神经介入指南对颅内动脉狭窄的缺血性卒中二级预防高级别推荐抗栓治疗 谢谢 * * WASID研究的结论：在症状性IAS 患者中狭窄程度严重者、事件发生在17 天内者是复发性狭窄动脉区域缺血性卒中的独立 预测因素，女性和入组时NIHSS＞1 分的患者也是复发性狭窄动脉区域缺血性卒中的高危人群，其中严重狭窄是最强的预测因素；而以往回顾性研究认为与复发性狭窄动脉区域缺血性卒中的危险有关联的2 个因素，即病变位于后循环（椎基底动脉）和抗栓治疗失败，在这个设计和实施严格的前瞻研究中未得到证实。 Background—Antithrombotic therapy for intracranial arterial stenosis was recently evaluated in the Warfarin versus Aspirin for Symptomatic Intracranial Disease (WASID) trial. A prespecified aim of WASID was to identify patients at highest risk for stroke in the territory of the stenotic artery who would be the target group for a subsequent trial comparing intracranial stenting with medical therapy. Methods and Results—WASID was a randomized, double-blinded, multicenter trial involving 569 patients with transient ischemic attack or ischemic stroke due to 50% to 99% stenosis of a major intracranial artery. Median time from qualifying event to randomization was 17 days, and mean follow-up was 1.8 years. Multivariable Cox proportional hazards models were used to identify factors associated with subsequent ischemic stroke in the territory of the stenotic artery. Subsequent ischemic stroke occurred in 106 patients (19.0%); 77 (73%) of these strokes were in the territory of the stenotic artery. Risk of stroke in the territory of the stenotic artery was highest with severe stenosis 70% (hazard ratio 2.03; 95% confidence interval 1.29 to 3.22; P0.0025) and in patients enrolled early (17 days) after the qualifying event (hazard ratio 1.69; 95% confidence interval 1.06 to 2.72; P0.028). Women were also at increased risk, although this was of borderline significance (hazard ratio 1.59; 95% confidence interval 1.00 to 2.55; P0.051). Location of stenosis, type of qualifying event, and prior use of antithrombotic medications were not associated with increased risk. Conclusions—Among patients with symptomati