급성 두개내 동맥폐색의 예후 및 결정인자

J Korean Neurol Assoc > Volume 27(4); 2009 > Article

Journal of the Korean Neurological Association 2009;27(4): 313-319.

Long-term Prognosis of Patients With Acute Intracranial Large Artery Occlusion and its Determining Factors

이웅우, 양미화 신채원 장명숙 김욱주 고영채 박정현 한문구 배희준

서울대학교 의과대학 분당서울대학교병원 신경과 뇌졸중센터

급성 두개내 동맥폐색의 예후 및 결정인자

Woong-Woo Lee

Department of Neurology, Seoul National University Bundang Hospital, Stroke Center, Seongnam, Korea

Abstract

Background: Acute intracranial large-artery occlusions (AILAOs) are detected frequently and cause severe neurological disabilities. Most studies in this field do not focus on the natural history of AILAOs, but on the individual prognosis for each intervention. The aim of this study was to elucidate the clinical profiles and outcomes of AILAOs.
Methods: A consecutive series of patients hospitalized between January 2004 and October 2007 due to AILAO within 24 hours from onset were recruited. Based on a prospective stroke registry, their clinical profiles were collected. AILAO was defined as an intracranial internal carotid artery (ICA), middle cerebral artery (MCA), or basilar artery (BA) occlusion that could be confirmed by angiography, with relevant lesions on diffusion-weighted imaging (DWI). The modified Rankin Scale (MRS) score at 3 months and the recanalization rate within 14 days were recorded as outcomes.
Results: Among 1,047 patients with acute ischemic stroke who were examined within 24 hours of onset, 189 [18.1%; 101 men, 88 women; age 68.6±13.0 years (mean±SD); median National Institutes of Health Stroke Scale (NIHSS) score=11]. Occlusion sites were MCA M1, MCA M2, distal ICA, and BA in 99 (52.4%), 50 (26.5%), 20 (10.6%), and 20 (10.6%) of cases, respectively. Embolic sources were found in 103 (54.5%) cases. MRS scores were available for 184 (97.4%) of the patients, of which 78 had a favorable outcome (MRS: 0?2). Follow-up angiography was performed in 122 (64.6%) cases, with recanalization observed in 88 (72.1%) of these. Thrombolysis, occlusion site, presence of an embolic source, and initial glucose level were predictors of early recanalization (p<0.001). Recanalization status and initial NIHSS score were strongly correlated with a favorable outcome (p<0.005).
Conclusions: This is the first report of the clinical profiles, outcomes, and their predictors in a cohort of Korean patients with AILAO. Key Words: Cerebrovascular occlusion, Intracranial embolism and thrombosis, Natural history