Clinical Characteristics, Risk Factors, and Outcomes of Arterial Dissection-Associated Stroke: A 21-Year Cohort Study from the Japan Stroke Data Bank.

IF 3 2区 医学 Q2 PERIPHERAL VASCULAR DISEASE
Kenichi Kashihara, Michikazu Nakai, Masatoshi Koga, Akira Handa, Shotai Kobayashi, Shiho Usumoto, Sohei Yoshimura, Kazunori Toyoda
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Abstract

Aim: To evaluate the risk factors, location, treatment, and outcomes of stroke due to arterial dissection, we examined these characteristics in a substantial, long-standing, nationwide stroke cohort.

Methods: The study participants were patients with acute stroke who were registered in the Japan Stroke Data Bank between January 1999 and December 2020. We focused on patients with stroke caused by extracranial or intracranial artery dissection and examined their clinical characteristics, treatments, and outcomes. In addition, we compared the results between clinical subtypes with and without dissection.

Results: Among the 218,799 registered patients with acute stroke, 1,353 (0.62%) were attributed to artery dissection. Of these, 880 patients had ischemic stroke, 16 had intracerebral hemorrhage, and 457 had subarachnoid hemorrhage (SAH). Dissection cases were most prevalent among individuals in their 40s and 50s, with intracranial vertebral artery dissection being the primary cause of ischemic stroke and SAH. Male sex, dyslipidemia, diabetes mellitus, and a history of smoking were associated with a higher likelihood of ischemic stroke than SAH. Unfavorable outcomes, defined as a modified Rankin score ≥ 4 at discharge, were observed in 18.9% of ischemic stroke cases and 42.6% of SAH cases with dissection. Neurological severity and older age at admission are associated with unfavorable outcomes in patients with ischemic stroke and SAH.

Conclusions: Ischemic stroke was the most frequent subtype of stroke in patients with arterial dissection, followed by SAH. Patients with stroke due to dissection were younger than those without. Neurological severity and older age at admission are substantial risk factors for unfavorable stroke outcomes due to artery dissection.

动脉夹层相关性卒中的临床特征、危险因素和结局:来自日本卒中数据库的21年队列研究
目的:为了评估动脉夹层卒中的危险因素、部位、治疗和结局,我们在一个长期存在的全国性卒中队列中研究了这些特征。方法:研究对象为1999年1月至2020年12月在日本卒中数据库中登记的急性卒中患者。我们研究了颅外或颅内动脉夹层引起的脑卒中患者,并检查了他们的临床特征、治疗方法和结果。此外,我们比较了有无解剖的临床亚型的结果。结果:218799例急性脑卒中患者中,1353例(0.62%)归因于动脉夹层。其中880例为缺血性卒中,16例为脑出血,457例为蛛网膜下腔出血(SAH)。夹层病例在40 - 50岁人群中最为普遍,颅内椎动脉夹层是缺血性卒中和SAH的主要原因。男性、血脂异常、糖尿病和吸烟史与缺血性卒中的可能性比SAH高。18.9%的缺血性脑卒中患者和42.6%的SAH合并夹层患者出现不良预后,即出院时修正Rankin评分≥4。缺血性卒中和SAH患者的神经系统严重程度和入院年龄与不良预后相关。结论:缺血性脑卒中是动脉夹层患者中最常见的脑卒中亚型,其次是SAH。夹层卒中患者比非夹层卒中患者年龄小。神经系统的严重程度和入院时的年龄是动脉夹层导致的不良卒中结果的重要危险因素。
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来源期刊
CiteScore
6.60
自引率
15.90%
发文量
271
审稿时长
1 months
期刊介绍: JAT publishes articles focused on all aspects of research on atherosclerosis, vascular biology, thrombosis, lipid and metabolism.
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