| Objective: The prevalence and morbidity of stroke gradually increases due to a high incidence of hypertension, diabetes, hyperlimipia respectively in chinese population. And with a decline of mortality from initial cerebral infarcts and an increase in the life expectancy of the population, the number of patients with recurrent stroke events will become greater. And recurrent stroke, which is characterized by higher disability and mortality, frequently leads to the lower quality of life. Thus, it is important to identify those stroke patients at high risk for stroke recurrence and to make early and appropriate therapeutic indications for preventing recurrent stroke and improving the prognosis of patients with stroke. Previous studies have suggested that patients with symptomatic carotid artery atherosclerosis have unacceptable higher rates of recurrent ischemic stroke events and death than the patients without large artery disease. This suggests that carotid artery occlusive disease is an important risk factor for recurrent stroke. However, intracranial atherosclerosis is the most common artery disease in Asian, especially middle cerebral artery. Therefore, middle cerebral artery occlusive disease (MCAOD) becomes an important risk factor of acute stroke patients in Asian. But no study was reported about the outcome of MCAOD patients with initial ischemic stroke in China. Thus, we study the recurrence rate of stroke events through following up the first-ever ischemic stroke patients with MCAOD. And then observe the risk factors of stroke recurrence and the possible pathogenesis of recurrent stroke in these patients. The present study may provide information about how to identify stroke patients at high risk for recurrence and how to prevent recurrent stroke in clinic.Methods:Between November 2001 to June 2003, patients with first-ever ischemic stroke in the territory of MCA were enrolled to our study. The lesion was confirmed by CT or MRI scan and chronic middle cerebral artery(MCA) stenosis or occlusion contributing to the ischemic events were diagnosed by TCD and/or MRA. We excluded the patients with severe carotid artery disease, potential source of cardioembolism or nonatherosclerotic MCA stenosis and the individuals lost during follow-up. On admission, the baseline data and stroke risk factors were registered for the recruited patients include sex, age, history of hypertension, diabetes mellitus, ischemic heart disease, hyperlipemia and previous transient ischemic attack(TIA). According to the peak systolic velocity of TCD, MCAOD were classified as follows: moderate stenosis, severe stenosis and occlusion. The distribution of infarcts within the MCA territory on CT or MRI were categorized as cortical territory infarct, borderzone infarct, and perforating artery infarct. Then we conducted a follow-up of 6 months after stroke onset by personal or telephone interview and recorded any ipsilateral ischemic stroke events during this period and antithrombotic agents. The univariate or multivariate analysis was used to estimate the impact of these risk factors on clinical recurrence in symptomatic MCAOD patients.Results:We studied 182 consecutive first-ever ischemic stroke patients with relevant MCAOD. The proportion of males was 2.4 times as high as that of females(128 males:54 females). Their mean age on admission was 64.0±10.2 years(ranged from 35 to 90 years). The risk profile of the study group included hypertension in 146 patients(80.2%), diabetes mellitus in 68(37.4%), ischemic heart disease in 45(24.7%), hyperlipemia in 70(38.5%), and previous TIA in 25(13.7%). Results showed that 24 patients(13.2%) had further ipsilateral stroke events during the 6-month period, including 18 cerebral infarcts, 5 TIAs and no cerebral hemorrhage. According to the stenosis degree of MCAOD, 89 MCAODs(48.9%) were considerd moderate stenosis, 77(42.3%) with severe stenosis and 16(8.8%) were occlusion. The number of stroke events varied significantly among the three groups: There were respectively 6(6.7%),... |
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