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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Infarct Recurrence in Intracranial Atherosclerosis: Results from the MyRIAD Study
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Infarct Recurrence in Intracranial Atherosclerosis: Results from the MyRIAD Study

机译：患有颅内动脉粥样硬化的Infarct复发：Myriad研究结果

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Background: Intracranial atherosclerotic disease (ICAD) is a common cause of ischemic stroke with a high risk of clinical stroke recurrence. Multiple mechanisms may underlie cerebral ischemia in this condition. The study's objective is to discern the mechanisms of recurrent ischemia in ICAD through imaging biomarkers of impaired antegrade flow, poor distal perfusion, abnormal vasoreactivity, and artery-to-artery embolism. Methods: This prospective multicenter observational study enrolled patients with recent (<= 21 days) ischemic stroke or transient ischemic attack (TIA) caused by ICAD with 50-99% stenosis treated medically. We obtained baseline quantitative MRA (QMRA), perfusion MRI (PWI), transcranial Doppler vasoreactivity (VMR), and emboli detection studies (EDS). The primary outcome was ischemic stroke in the territory of the stenotic artery within 1 year of follow-up; secondary outcomes were TIA at 1 year and new infarcts in the territory on MRI at 6-8 weeks. Results: Amongst 102 of 105 participants with clinical follow-up (mean 253 +/- 131 days), the primary outcome occurred in 8.8% (12.7/100 patient-years), while 5.9% (8.5/100 patient-years) had a TIA. A new infarct in the territory of the symptomatic artery was noted in 24.7% at 6-8 weeks. A low flow state on QMRA was noted in 25.5%, poor distal perfusion on PWI in 43.5%, impaired vasoreactivity on VMR in 67.5%, and microemboli on EDS in 39.0%. No significant association was identified between these imaging biomarkers and primary or secondary outcomes. Conclusions: Despite intensive medical management in ICAD, there is a high risk of clinical cerebrovascular events at 1 year and an even higher risk of new imaging-evident infarcts in the subacute period after index stroke. Hemodynamic and plaque instability biomarkers did not identify a higher risk group. Further work is needed to identify mechanisms of ischemic stroke and infarct recurrence and their consequence on long-term physical and cognitive outcomes.
机译：背景：颅内动脉粥样硬化疾病（ICAD）是缺血性卒中的常见病因，临床卒中复发的风险很高。在这种情况下，脑缺血可能有多种机制。该研究的目的是通过顺行血流受损、远端灌注不良、异常血管反应性和动脉间栓塞的成像生物标志物来识别ICAD中反复缺血的机制。方法：这项前瞻性多中心观察性研究纳入了近期（<=21天）因ICAD引起的缺血性中风或短暂性脑缺血发作（TIA）患者，其狭窄率为50-99%。我们获得了基线定量MRA（QMRA）、灌注MRI（PWI）、经颅多普勒血管反应性（VMR）和栓子检测研究（EDS）。主要转归是随访1年内狭窄动脉区域的缺血性卒中；次要转归是1年时出现短暂性脑缺血发作，6-8周时MRI显示该区域出现新梗死。结果：在105名接受临床随访（平均253+/-131天）的参与者中，102名参与者的主要转归发生在8.8%（12.7/100患者年），而TIA发生率为5.9%（8.5/100患者年）。在6-8周时，24.7%的患者在症状动脉区域发现新的梗死。25.5%的QMRA患者出现低血流状态，43.5%的PWI患者出现远端灌注不良，67.5%的VMR患者出现血管反应性受损，39.0%的EDS患者出现微栓子。这些影像学生物标记物与主要或次要结果之间未发现显著相关性。结论：尽管对ICAD进行了密集的医疗管理，但在1年时临床脑血管事件的风险很高，在指数卒中后的亚急性期，新的影像学表现明显梗死的风险更高。血液动力学和斑块不稳定性的生物标记物并不能确定高风险组。需要进一步的工作来确定缺血性中风和梗死复发的机制及其对长期身体和认知结果的影响。

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