Borderzone Infarcts and Recurrent Cerebrovascular Events in Symptomatic Intracranial Arterial Stenosis: A Systematic Review and Meta-Analysis.

IF 6 1区医学 Q1 CLINICAL NEUROLOGY

Journal of Stroke Pub Date : 2023-05-01 Epub Date: 2023-05-30 DOI:10.5853/jos.2023.00185

Saurav Das, Liqi Shu, Rebecca J Morgan, Asghar Shah, Fayez H Fayad, Eric D Goldstein, Dalia Chahien, Benton Maglinger, Satish Kumar Bokka, Cory Owens, Mehdi Abbasi, Alexandra Kvernland, James E Siegler, Brian Mac Grory, Thanh N Nguyen, Karen Furie, Pooja Khatri, Eva Mistry, Shyam Prabhakaran, David S Liebeskind, Jose G Romano, Adam de Havenon, Lina Palaiodimou, Georgios Tsivgoulis, Shadi Yaghi

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引用次数: 0

Abstract

Background and purpose: Intracranial arterial stenosis (ICAS)-related stroke occurs due to three primary mechanisms with distinct infarct patterns: (1) borderzone infarcts (BZI) due to impaired distal perfusion, (2) territorial infarcts due to distal plaque/thrombus embolization, and (3) plaque progression occluding perforators. The objective of the systematic review is to determine whether BZI secondary to ICAS is associated with a higher risk of recurrent stroke or neurological deterioration.

Methods: As part of this registered systematic review (CRD42021265230), a comprehensive search was performed to identify relevant papers and conference abstracts (with ≥20 patients) reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAS. Subgroup analyses were performed for studies including any BZI versus isolated BZI and those excluding posterior circulation stroke. The study outcome included neurological deterioration or recurrent stroke during follow-up. For all outcome events, corresponding risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated.

Results: A literature search yielded 4,478 records with 32 selected during the title/abstract triage for full text; 11 met inclusion criteria and 8 studies were included in the analysis (n=1,219 patients; 341 with BZI). The meta-analysis demonstrated that the RR of outcome in the BZI group compared to the no BZI group was 2.10 (95% CI 1.52-2.90). Limiting the analysis to studies including any BZI, the RR was 2.10 (95% CI 1.38-3.18). For isolated BZI, RR was 2.59 (95% CI 1.24-5.41). RR was 2.96 (95% CI 1.71-5.12) for studies only including anterior circulation stroke patients.

Conclusion: This systematic review and meta-analysis suggests that the presence of BZI secondary to ICAS may be an imaging biomarker that predicts neurological deterioration and/or stroke recurrence.

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查看原文本刊更多论文

无症状颅内动脉狭窄的边区梗死和复发性脑血管事件：系统回顾与元分析》。

背景和目的：颅内动脉狭窄（ICAS）相关卒中的发生有三种主要机制，其梗死模式各不相同：（1）远端灌注受损导致的边界区梗死（BZI）；（2）远端斑块/血栓栓塞导致的区域性梗死；以及（3）斑块进展堵塞穿孔器。本系统综述的目的是确定继发于 ICAS 的 BZI 是否与较高的复发性卒中或神经功能恶化风险相关：方法：作为注册系统综述（CRD42021265230）的一部分，我们进行了全面检索，以确定报道无症状 ICAS 患者初始梗死模式和复发率的相关论文和会议摘要（患者人数≥20 人）。对包括任何 BZI 与孤立 BZI 的研究以及排除后循环卒中的研究进行了分组分析。研究结果包括随访期间神经功能恶化或卒中复发。对于所有结果事件，均计算了相应的风险比（RR）和 95% 置信区间（95% CI）：通过文献检索获得了 4478 条记录，其中 32 条在标题/摘要分流中被选中进行全文检索；11 条符合纳入标准，8 项研究被纳入分析（n=1,219 名患者；341 人使用 BZI）。荟萃分析表明，BZI组与无BZI组相比，结果的RR为2.10（95% CI为1.52-2.90）。将分析局限于包括任何 BZI 的研究，RR 为 2.10（95% CI 1.38-3.18）。孤立 BZI 的 RR 为 2.59 (95% CI 1.24-5.41)。仅包括前循环卒中患者的研究的 RR 为 2.96 (95% CI 1.71-5.12)：本系统综述和荟萃分析表明，继发于 ICAS 的 BZI 可能是预测神经功能恶化和/或卒中复发的影像生物标志物。

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来源期刊

Journal of Stroke CLINICAL NEUROLOGYPERIPHERAL VASCULAR DISE-PERIPHERAL VASCULAR DISEASE

CiteScore

11.00

自引率

3.70%

发文量

审稿时长

12 weeks

期刊介绍： The Journal of Stroke (JoS) is a peer-reviewed publication that focuses on clinical and basic investigation of cerebral circulation and associated diseases in stroke-related fields. Its aim is to enhance patient management, education, clinical or experimental research, and professionalism. The journal covers various areas of stroke research, including pathophysiology, risk factors, symptomatology, imaging, treatment, and rehabilitation. Basic science research is included when it provides clinically relevant information. The JoS is particularly interested in studies that highlight characteristics of stroke in the Asian population, as they are underrepresented in the literature. The JoS had an impact factor of 8.2 in 2022 and aims to provide high-quality research papers to readers while maintaining a strong reputation. It is published three times a year, on the last day of January, May, and September. The online version of the journal is considered the main version as it includes all available content. Supplementary issues are occasionally published. The journal is indexed in various databases, including SCI(E), Pubmed, PubMed Central, Scopus, KoreaMed, Komci, Synapse, Science Central, Google Scholar, and DOI/Crossref. It is also the official journal of the Korean Stroke Society since 1999, with the abbreviated title J Stroke.