症状性椎动脉颅内段非急性闭塞血管内开通治疗研究

目的探讨症状性椎动脉颅内段非急性闭塞(SNAIVAO)血管内开通治疗的有效性和安全性。方法回顾性分析2017年7月至2019年6月河南省人民医院脑血管病中心闭塞超过24 h的SNAIVAO并接受血管内开通治疗患者的临床及随访资料,分析围手术期并发症、术前术后改良Rankin量表(mRS)评分、随访期间支架再狭窄及卒中复发事件。采用脑梗死溶栓(TICI)分级评估血管再通与否(TICI≥2b为血管成功再通)。结果共纳入符合纳排标准的24例SNAIVAO患者,其中23例成功开通(TICI均为3级),术后半年22例患者病情改善,2例稳定,mRS评分由术前的中位评分4(2,5)分恢复至出院时的中位评分3(2,4)分,术后半年的mRS中位评分为2(1,3)分。术前与出院前(Z=-3. 153,P=0. 002)、术后6个月(Z=-4. 069,P 0. 05)的mRS评分比较,差异均有统计学意义。24例术中,3例并发夹层,1例神经症状加重。术后6个月DSA影像随访的17例患者中,再发狭窄6例,其中同侧短暂性脑缺血发作2例,再发卒中1例。结论 SNAIVAO的闭塞段虽较长,但成功开通率高,安全性高,临床预后好,开通血管远期再狭窄率较高。     

症状性非急性大脑中动脉闭塞血管内再通治疗效果的初步分析

目的分析症状性非急性大脑中动脉闭塞血管内再通治疗的临床效果。方法回顾性连续纳入2016年1月至2020年1月于浙江省立同德医院神经内科住院的症状性非急性大脑中动脉粥样硬化性闭塞接受血管内介入治疗再通患者9例,收集患者的一般及临床资料,包括血管内治疗方法、血管再通结果、围手术期并发症和术后6个月时的临床、头部CT血管成像(CTA)及CT灌注(CTP)随访数据,并进行初步分析。术后双重抗血小板聚集及强化他汀治疗3个月后,阿司匹林及常规剂量他汀类药物口服,术后6个月门诊随访。采用脑梗死溶栓试验(TICI)分级评估术后即刻血管再通情况(TICI≥2b级为血管成功再通),美国国立卫生研究院卒中量表(NIHSS)评分评估患者基线及治疗1周后神经功能,采用改良Rankin量表(mRS)评估术后6个月时患者的预后(mRS评分≤2分为预后良好)。结果 9例患者闭塞血管均获得成功再通,术中发生并发症3例,包括1例症状性远端栓塞、1例闭塞动脉开通部位夹层、1例高灌注综合征表现。术后6个月随访,9例患者均无卒中及短暂性脑缺血发作复发,7例获得良好预后; 8例进行了头部CTA及CTP复查,示2例支架内轻度再狭窄,脑灌注均正常。结论症状性非急性大脑中动脉闭塞患者经评估后血管内再通治疗可能是相对安全有效的,但确切的疗效需要大规模的随机对照研究证实。     

血管支架成形术治疗症状性脑动脉狭窄47例疗效观察

采用血管支架成形术治疗症状性脑动脉狭窄患者47例,结果 手术成功率100%;术后随访6～18个月,未发生新卒中或短暂性脑缺血发作,影像学检查显示均无再狭窄.术中出现一过性心率缓慢、血压下降4例,颅内动脉远端血管痉挛2例;术后第2天出现上消化道出血1例,经治疗后症状均消失.提示血管支架成形术治疗症状性脑动脉狭窄比较安全,短期疗效较好.     

高分辨率核磁共振管壁成像技术在头颈动脉闭塞病因诊断中的应用价值

目的探讨高分辨率MRI(high-resolution MRI,HR-MRI)在头颈部动脉闭塞患者病因诊断中的价值。方法前瞻性连续纳入2015年12月至2017年2月首都医科大学宣武医院急性头颈动脉闭塞患者25例,采用32通道头颈联合专用线圈行头颈一体化HR-MRI成像,分析闭塞血管节段局部管壁特征和闭塞中远段腔内血栓信号特征。由2名神经内科医师结合纳入患者的临床病史、实验室检查、影像学检查对闭塞病因进行评价并作为参考标准,比较常规管腔成像技术与常规管腔成像联合HR-MRI在病因分类中的准确率。结果 (1)25例急性头颈动脉闭塞患者均完成HR-MRI检查,共诊断闭塞血管31段,其中常规管腔成像诊断了21段,常规管腔成像+HR-MRI诊断了30段;动脉硬化性闭塞24段(19例),动脉夹层性闭塞4段(4例),动脉炎性闭塞3段(2例)。(2)动脉硬化性闭塞患者中,闭塞节段近端管壁均可见偏心性增厚;动脉夹层性闭塞均见典型的双腔征或新月形高信号壁内血肿;血管炎性闭塞血管节段中可见长节段环形增厚及强化。(3)常规管腔成像技术与常规管腔成像联合HR-MRI对病因分类诊断的准确率分别为67.7%(21/31)和96.8%(30/31),差异有统计学意义(P0.01)。结论相较于常规管腔成像技术,头颈联合HR-MRI可显示闭塞起始段动脉管壁特征,对判读动脉粥样硬化、动脉夹层和动脉炎性病变等病因具有一定优势。     

单纯球囊扩张成形治疗慢性颈内动脉颅内段局限性闭塞一例

颈内动脉闭塞是引起缺血性卒中的主要原因之一,存在血流动力学障碍,发生卒中的风险可能更高。患者可以表现为无症状、短暂性脑缺血发作、肢体抖动、认知障碍及急性卒中等,容易漏诊及误诊。早期发现、早期干预可获得良好预后和生活质量。严格、详尽的病史采集、影像学评估为介入开通血管创造良好的条件,也是介入开通后患者良好预后的基础。作者回顾性报道1例症状性慢性颈内动脉颅内段局限性闭塞患者行单纯球囊扩张血管成形术治疗的过程及预后,并结合相关文献,分析探讨了慢性颈内动脉闭塞导致血管事件的可能原因及介入治疗的利与弊。     

颅内大动脉慢性闭塞血管内再通的可行性和安全性分析

目的探讨血管内介入再通颅内大动脉慢性闭塞的可行性和安全性。方法回顾性分析2009年1月至2017年1月首都医科大学宣武医院神经外科血管内介入再通的15例颅内大动脉慢性闭塞患者的临床和影像学资料。12例为椎动脉V4段闭塞,3例为颈内动脉颅内段闭塞。术前采用全脑DSA评估闭塞长度和位置,用高分辨率MRI评估闭塞性质和再通可行性;术中双侧股动脉置鞘13例,一侧用于再通置入支架,另一侧通过侧支循环代偿充盈闭塞动脉远端作为参考路径图,增加再通可行性。术后根据脑梗死溶栓(TICI)分级系统评估再通后的顺向血流,定义≥2b级为血管成功再通。结果 15例患者首次症状发作到再通时间中位数为50(18~365)d。再通成功13例,2例椎动脉颅内段再通失败。13例再通成功患者中,12例再通后复查造影正向血流恢复至TICI 3级,1例TICI 2b级;7例症状好转,4例症状无变化,1例术后出现短暂性脑缺血发作、1例出现卒中。11例患者随访中位数时间39(3~89)个月后,改良Rankin量表评分中位数为1(0~2)分。结论颅内大动脉慢性闭塞再通,术前采用高分辨率MRI评估以及术中双侧置鞘技术,可能会增加开通率和降低围手术期并发症。     

经皮血管成形术治疗症状性颅内椎-基底动脉狭窄的临床研究

目的探讨采用血管成形术治疗症状性颅内椎-基底动脉狭窄的预后及疗效。方法回顾性分析2002年9月—2007年3月采用血管成形术治疗的症状性颅内椎-基底动脉狭窄患者（狭窄率≥50%）,共112例（116处）,其中椎动脉颅内段狭窄68处,基底动脉狭窄48处。评估术后即刻治疗效果,手术成功率、并发症及病死率。术后每3个月行临床及影像学随访1次,评估卒中发生、症状改变情况及再狭窄情况。结果①114处成功置入支架,2处因椎动脉颅内段极度迂曲,支架无法到位,采用单纯球囊扩张成形术。114处中,78处管径恢复正常,34处残余狭窄率〈10%,4处残余狭窄率约为30%。血管狭窄率由术前的（84±8）%,下降至术后的（8±7）%,P〈0.01。②术后1周,6例（5.4%）患者出现与手术有关的并发症,其中急性血栓形成1例,穿支动脉闭塞3例,症状性颅内出血2例;死亡2例（1.8%）。③64例患者获得3～54个月的随访,平均（18±11）个月。其中2例（3.1%）死亡,8例（12.5%）发生再狭窄（复查DSA,再狭窄率为50%～90%）。结论采用血管成形术治疗症状性颅内椎-基底动脉狭窄是安全有效的,经短中期随访其疗效满意。     

中西药结合血管内支架成形术治疗症状性大脑中动脉狭窄

目的 探讨中西药结合血管内支架成形术治疗症状性大脑中动脉狭窄的应用.方法 在中西药结合治疗基础上,对临床诊断分水岭脑梗死15例和短暂性脑缺血发作10例患者行全脑血管造影术,发现大脑中动脉M1段存在不同程度狭窄,对狭窄段大脑中动脉行颅内支架成形术.结果 25例大脑中动脉支架成形术均获得成功.大脑中动脉M1段平均直径狭窄程度从90.8 %降至10%～20%(P＜0.01).术后随访6个月,所有患者均无脑缺血事件发生.结论 采用中西药结合血管内支架成形术治疗症状性大脑中动脉狭窄可行.     

Solitaire AB在前循环远端动脉急性闭塞取栓治疗中的初步应用

目的探讨应用机械取栓装置Solitaire AB治疗颅内动脉远端闭塞所致前循环急性缺血性卒中的效果。方法回顾性分析采用Solitaire AB取栓装置治疗的9例前循环远端动脉闭塞患者的资料,其中大脑中动脉M2段闭塞7例,大脑前动脉A3段闭塞2例。分析9例患者的临床特征、影像学资料、治疗及术后3个月临床随访结果。以支架取栓后再通率、治疗前后美国国立卫生研究院卒中量表(NIHSS)评分及术后3个月随访时改良Rankin量表(mRS)评分评估治疗的有效性,以手术相关并发症、病死率评估治疗的安全性。结果 (1)9例患者中,8例成功再通,改良脑梗死溶栓试验(mTICI)分级2b或3级。(2)出院时NIHSS评分中位数9.5(3.0,15.5)分,较术前19.0(16.0,22.0)分明显下降(Z=2.703,P=0.007),未发生操作相关永久性并发症。再通的8例患者中,4例预后良好(mRS评分为0~1分),4例残疾(mRS评分为3~4分);未再通的1例患者术后3个月随访时mRS评分为4分。结论颅内动脉M2段或A3段急性闭塞时,使用Solitaire AB取栓效果较好,其有效性、安全性及适应证尚需更大样本的对照研究进一步探索。     

血管成形术治疗症状性颅内动脉粥样硬化性狭窄的临床疗效观察

目的探讨血管成形术治疗症状性颅内动脉粥样硬化性狭窄的临床疗效。方法纳入2010年9月—2013年6月南京卒中注册系统中经规范的内科治疗失败后,行血管成形术的症状性颅内动脉狭窄患者82例。其中9例行单纯球囊扩张术,73例行颅内支架置入术。发病至手术的中位时间为24.5 d。评估术后终点事件(术后≤30 d任何卒中、死亡及30 d责任血管供血区缺血性卒中或原狭窄处因再狭窄需要再次治疗)发生情况。影像学随访(CTA或DSA)再狭窄的发生率。结果 (1)82例中,手术成功率为92.7%(76例)。78例(95.1%)接受随访,失访4例。中位随访时间为22.5个月(四分位数:9,29个月)。10例发生终点事件,7例为缺血性卒中,1例为脑出血,2例为无症状重度再狭窄再次置入支架的患者。3例终点事件发生于术后≤30 d(均发生于术后≤24 h)。Kaplan-Meier曲线显示,1、6、12、24个月累积终点事件发生率分别为3.7%、8.6%、11.0%、13.0%。(2)60例(73.2%)患者接受影像学(11例行CTA,49例行DSA)检查,其中17例(28.3%)发生再狭窄,症状性再狭窄的发生率为5.0%(3例),无症状的为23.3%(14例)。结论经综合评估、严格筛选后,血管成形术治疗内科治疗无效的症状性颅内动脉狭窄患者,安全性高,中、远期疗效满意。     

Neuroform支架在治疗症状性颅内动脉狭窄中的应用

目的评价使用Neuroform支架在治疗症状性颅内动脉狭窄的安全性、可行性。方法症状性颅内动脉狭窄患者11例,其中前循环狭窄2例(1例狭窄位于颈内动脉眼段交通段,1例狭窄位于大脑中动脉M1段),后循环狭窄9例(3例狭窄位于基底动脉,6例狭窄位于基底动脉交界处);均进行支架成形术治疗,术后全脑血管造影复查及使用美国国立卫生研究院脑卒中量表(NIHSS)进行评定。结果11例患者支架全部置放成功,造影复查显示动脉直径狭窄率从术前(85.6±7.4)%降至术后(35.7±12.1)%。按NIHSS评分评估,11例患者术后症状明显改善,其中1例患者术后15天出现Wallenberg综合征,随访1~12个月,其他患者未出现脑缺血再发作及支架内再狭窄。结论应用Neuroform支架治疗症状性颅内动脉狭窄合并路径血管纡曲不光滑的患者,可以提高手术成功率,减轻临床缺血症状和改善预后。     

Solitaire支架半释放保护技术治疗急性颈内动脉串联闭塞患者的效果分析

目的探讨使用Solitaire支架半释放保护(SHARP)技术逆行处理串联闭塞的安全性和疗效。方法回顾性连续纳入2017年1月至2019年3月陆军特色医学中心神经内科接受血管内治疗的14例急性缺血性卒中颈内动脉串联闭塞患者的临床及影像学资料,且均使用SHARP技术。采用急性卒中Org 10172治疗试验(TOAST)病因分型:大动脉粥样硬化型、心源性栓塞型、小血管病变型、其他病因型和不明原因型。先将导引导管及中间导管挤过近端闭塞处进行颅内血管闭塞段支架取栓,然后使用SHARP技术,将SolitaireAB支架半释放至颈内动脉,起到类似于远端栓塞保护装置的作用,再将导管退至颈总动脉,经血管造影确认是否存在远端栓塞,同时根据造影评估结果选择近端取栓或支架置入。若造影显示前向血流无法维持或残余狭窄过重,则行颈动脉支架置入术。术后成功再通定义为脑梗死溶栓(TICI)分级达2b级或3级。术后即刻及术后(24±6)h复查头部平扫CT评估不良事件,包括术中并发症(血管痉挛、远端栓塞事件)、与SHARP技术相关并发症[支架半释放后和(或)导引导管后退至颈内动脉狭窄近端时,经DSA证实出现了远端栓塞事件]、出血转化(出血性梗死Ⅰ型、出血性梗死Ⅱ型、脑实质出血Ⅰ型、脑实质出血Ⅱ型)、蛛网膜下腔出血、症状性颅内出血。术后7 d或出院时美国国立卫生研究院卒中量表(NIHSS)评分较入院时至少降低4分为神经功能改善。以90 d随访记录评价临床预后,以改良Rankin量表(mRS)评分≤2分为神经功能独立,mRS评分>2分为预后不良,其中6分为死亡。结果14例串联闭塞患者均为颈内动脉起始部闭塞,有8例合并颈内动脉终末闭塞(C7段闭塞),6例合并大脑中动脉M1段闭塞;病因分型以大动脉粥样硬化型9例,心源性栓塞型3例,动脉夹层2例。14例患者均成功再通,达TICI分级2b级或3级;穿刺至再通的平均时间为(63±6)min;4例患者再通后因前向血流无法维持而行颈内动脉支架置入术(大动脉粥样硬化型3例,动脉夹层1例)。未发生SHARP技术相关并发症(远端栓塞事件)。14例患者中,术后发生脑实质出血1例、出血性梗死3例、蛛网膜下腔出血1例,无症状性颅内出血。术后90 d随访,1例因神经功能恶化死亡,10例患者达神经功能独立(mRS评分≤2分),3例预后不良。结论对急性缺血性卒中串联闭塞患者使用SHARP技术逆行处理的初步分析显示,该技术可减少操作步骤,使手术时间缩短,一定程度上减少了急性期支架置入。但该项技术的安全性及有效性仍需进一步验证。     

Angioplasty and stenting for the occluded internal carotid artery

To investigate the feasibility and efficacy of angioplasty and stenting for symptomatic occlusion of carotid artery. From December 2004 to June 2009, 17 patients with progressive or reoccurred ischemic stroke or repeated transient ischemic attack resulted from the total occluded carotid artery underwent angioplasty and stenting were reviewed. All patients with successful procedure were followed up. Clinic and angiography data were documented prospectively. The median time from symptoms onset to procedure was 23 days (range 3–94 days). Twelve of the 17 patients (70%) were obtained technique success. Eight patients were observed the collapse of internal carotid artery between occluded location to origin of ophthalmic artery after the occlusion was patent. Two patients had clots which were solved with urokinase. The collapsed internal carotid artery was improved markedly in the compute tomography angiograph 7 days after the procedure. No any complications related procedures occurred. One patient died from myocardial infarct and one suffered from ischemic minor stroke in brainstem for a median follow-up of 346.5 days. One of 9 patients (11.1%) was observed in-stent stenosis in the follow-up angiography. Angioplasty and stenting was a potential alternative therapy for symptomatic occlusion of carotid artery. Further study is required to determine the safety of this treatment.     

症状性前循环颅内动脉狭窄的血管内治疗

目的探讨前循环颅内动脉狭窄患者经皮腔内血管成形术(PTA)及经皮腔内血管成形支架置入术(PTAS)治疗的效果。方法39例(男31例,女8例)经药物治疗无效、反复短暂性脑缺血发作(TIA)或有明显脑缺血症状的前循环颅内动脉狭窄患者,经数字减影血管造影术(DSA)诊断后,行PTA或PTAS治疗。术后常规给予抗血小板治疗,DSA及经颅多普勒超声(TCD)进行影像学随访。结果39例前循环颅内动脉狭窄患者行PTA或PTAS均获成功,术后残余狭窄程度均<20%,临床脑缺血症状和体征明显改善。1例患者术中见对比剂外泄但无明显临床症状,且恢复良好,余患者无并发症发生。临床随访无TIA或脑梗死再发,其中2例行DSA复查、19例行TCD复查,均无再狭窄发生。结论PTA或PTAS治疗前循环颅内动脉狭窄是可行、安全、有效的。     

Angioplasty in total coronary artery occlusion: experience in 76 consecutive patients

The influence of multiple clinical, angiographic and technical variables on the outcome of percutaneous transluminal coronary angioplasty was evaluated in a group of 76 consecutive patients with total coronary artery occlusion. Angioplasty was performed successfully in 53% of these patients. The likelihood of successful angioplasty was favorably influenced by: 1) a history of prior myocardial infarction in the distribution of the occluded arterial segment (p = 0.03); 2) an estimated maximal duration of arterial occlusion of less than 20 weeks (p less than 0.001); and 3) a length of nonvisualized arterial segment distal to the point of occlusion of less than 1.5 cm (p = 0.03). The outcome of coronary angioplasty was not significantly influenced by the vessel involved, the location of the occlusion within an involved vessel, the morphology of the occlusion (tapered versus abrupt) or the age and sex of the patient. There were no deaths and no vascular perforations. Four patients had recurrent coronary occlusion within 24 hours of the procedure; in three of these, recurrent occlusion was successfully treated with reangioplasty and in one, emergent surgical revascularization was performed. Embolic occlusion of an arterial branch distal to the point of total coronary occlusion occurred in 4 of the 40 successfully recanalized arteries. Seventy-five percent of patients having successful recanalization of an occluded coronary artery were free of the anginal symptoms that had prompted performance of the procedure at a mean follow-up period of 7.3 months. Thus, angioplasty of a total coronary artery occlusion can be performed safely and effectively, particularly in patients with a history of prior myocardial infarction, a brief estimated duration of coronary occlusion and a short nonvisualized occluded arterial segment.     

尿激酶动脉溶栓联合支架置入术与单纯尿激酶动脉溶栓治疗缺血性卒中的比较

目的 比较尿激酶动脉溶栓+支架置入术与单纯尿激酶动脉溶栓治疗缺血性卒中的安全性和有效性.方法 回顾性分析64例急性颈内动脉系统脑梗死患者.其中,单纯动脉溶栓组(仅采用尿激酶动脉溶栓)38例,支架置入组(在尿激酶动脉溶栓基础上行支架置入)26例.收集两组病例的医疗和神经影像学资料,比较血管再通率、有症状颅内出血和(或)死亡发生率.采用3个月时改良Rankin量表(modified Rankin Scale,mRS)评分评价两组病例的临床转归.结果 64例缺血性卒中患者中,55例(85.9%)存在血管闭塞,9例(14.0%)存在血管严重狭窄.支架置入组血管再通率为88.5%(23/26),显著高于单纯动脉溶栓组的47.4%(18/38)(χ2=16.6,P=0.00).与单纯动脉溶栓组相比,支架置入组3个月时mRS评分＜2分的患者比例显著增高(47.4%对73.1%,χ2=4.18,P=0.04),有症状颅内出血或死亡发生率无显著差异(7.8%对7.7,χ2=0.00,P=0.97).结论 对闭塞和重度狭窄动脉行尿激酶动脉溶栓联合支架置入术治疗急性缺血性卒中患者的血管再通率高于单纯尿激酶动脉溶栓,且远期转归更好.

Abstract：

Objective To compare the safety and efficacy of intra-arterial urokinase thrombolysis alone and intra-arterial urokinase thrombolysis + stenting for ischemic stroke. Methods Sixty-four patients with acute cerebral infarction in the internal carotid artery system were analyzed retrospectively. The patients were divided into intra-arterial thrombolysis group (n = 38; using urokinase only) and stenting group (n = 26; using urokinase + stenting). The medical and imaging data of the patients in both groups were collected. The revascularization rate, and symptomatic intracranial hemorrhage and/or mortality rates were compared. The modified Rankin Scale (mRS) scores at 3 months were used to evaluate the clinical outcome in both groups. Results Of the 64 patients with ischemic stroke, 55 (85. 9%) had vascular occlusion, 9 (14. 0% ) had severe arterial stenosis. The revascularization rate in the thromborysis group was 47.4% (18/38), and that in the stenting group was 88.5% (23/26). Compared to the drug thrombolysis group, the proportion of patients whose mRS scores ＜2 at 3 months after procedure (47. 4% vs. 73. 1%,χ2 = 4. 18,P = 0. 00). There was no significant difference between the symptomatic intracranial hemorrhage rate and death rate (7. 8% vs. 7.7% , χ2 = 0.00, P =0. 62). Conclusions When patients with acute ischemic stroke are treated with ultra-early endovascular treatment, the revascularization rate of the occlusion and severe artery stenosis treated with mechanical recanalization + stenting was significantly higher than that of the simple intra-arterial thrombolytic drug, and the long-term clinical outcome is better.     

Spontaneous recanalization of internal carotid artery occlusion evaluated with color flow imaging and contrast arteriography.

AIM: In strokes of embolic origin a partial recanalization of the intracranial occluded vessel occurs with a high incidence (as high as 80%). In the literature, we find few cases of revascularization, detected with color flow imaging (CFI) or with arteriography (AGF), at carotid siphon or at the origin of an occluded internal carotid artery (ICA). Up to now there have been no reliable data on the incidence and clinical consequences of SR of an extracranial ICA occlusion. In this case-report we document 8 cases of SR of occluded ICA observed in the last 10 years in our Care Unit. METHODS: We observed 8 complete ICA occlusion at the origin, detected with CFI (8 of 8) and with AGF (7 of 8). All symptomatic patients and 2 of 5 asymptomatic patients underwent CT scan in the acute phase of stroke. All patients underwent CFI follow-up (every 6-12 monhts) to evaluate contralateral CCA and ICA and the presence of new focal neurological symptoms. All patients assumed BMT (antiplatelet or anticoagulant therapy). RESULTS: SR occurred in 6 patients between 24 and 96 months, in 1 patient within 8 months and 1 patient within 6 months from the diagnosis of ICA occlusion. Diagnosis of SR was based in all patients with CFI and in 4 patients confirmed with AGF. Five patients underwent CT scan that excluded haemorrhagic transformation of previous ischemic areas or new ischemic events (2 patients did CT scan only after SR). All patients underwent CFI follow-up in a 3-88 months period. There were no new focal neurological symptoms in 7 of 8 patients, 1 patient presented aspecific neurological symptoms. CONCLUSION: Diagnosing SR of occluded extracranical ICA seems to be more frequent than expected. SR is an event that has to be researched in follow-up of these patients; besides, it seems to have a relatively benign outcome with respect to the onset of new neurological symptoms.     

轻型缺血性卒中患者转归不良的预测因素：前瞻性队列研究

目的 探讨轻型缺血性卒中患者的功能转归并明确其转归不良的危险因素.方法 前瞻性纳入发病后72 h内就诊的轻型缺血性卒中患者,根据发病后90 d时改良Rankin量表（modified Rankin Scale,mRS）评分将患者分为转归不良组（mRS评分＞2分）和转归良好组（mRS评分0～2分）.采用单变量分析和多变量logistic回归分析对人口统计学资料、血管危险因素、临床资料、实验室检查资料、影像学资料和随访资料进行比较和分析,明确轻型缺血性卒中转归不良的危险因素.结果 共纳入253例轻型缺血性卒中患者,其中71例（28.1％）转归不良.单变量分析显示,转归不良组年龄（=2.037,P=0.043）、基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分（U=4 610.000,P=0.000）、基线mRS评分（U=5 723.000,P=0.000）以及既往缺血性卒中史（x2 =4.950,P=0.026）、有症状大血管重度狭窄或闭塞（x2=49.037,P=0.000）、大动脉粥样硬化型卒中（x2=34.359,P=0.000）、早期神经功能恶化（x2=45.804,P=0.000）、并发肺炎（x2=12.121,P=0.000）以及缺血性卒中复发（x2=14.305,P=0.000）的患者比例显著性高于转归良好组.多变量logistic回归分析显示,高龄[优势比（odds ratio,OR）1.049,95％可信区间（confidence interval,CI）1.012 ～1.086;P=0.008]、基线mRS评分较高（OR 2.130,95％ CI 1.212～3.743;P=0.009）、基线NIHSS评分较高（OR 1.532,95％ CI 1.064 ～2.206;P=0.022）、有症状大血管重度狭窄或闭塞（OR 7.569,95％ CI 3.497～ 16.380;P=0.000）、早期神经功能恶化（OR 7.369,95％ CI2.648～20.510;P =0.000）和缺血性卒中复发（OR 10.450,95％ CI 3.071 ～35.564;P=0.000）是转归不良的独立危险因素.结论 超过1/4的轻型缺血性卒中患者转归不良,高龄、基线mRS评分较高、基线NIHSS评分较高、有症状大血管重度狭窄或闭塞、早期神经功能恶化以及缺血性卒中复发是其?