두개내 동맥경화증이 뇌경색 이후의 장기 사망률에 미치는 영향

Abstract

Background: Intracranial cerebral atherosclerosis (ICAS) is an important cause of stroke, but it is not well-known whether and how much it contributes to the long-term prognosis of stroke patients. The purpose of this study was to elucidate the impact of ICAS on the long-term mortality of patients with acute ischemic stroke. Methods: From November 1998 to December 2002, a consecutive series of 1306 patients who were hospitalized due to acute ischemic stroke were listed in the stroke registry. Among them, 946 patients who underwent brain MRI and MRA were selected and their vital status was identified by the National Death certificates. Results: Among 946 subjects, 624 (65.9%) had ICAS, while 106 (11.2%) had extracranial carotid atherosclerosis (ECAS). During a period of 59 months (27±16 months), 220 patients died. The 30-day, 1-year, 2-year, 3-year, and 4-year mortalities were 2.8%, 14.5%, 22.9%, 27.8% and 35.1% for those with ICAS (N=624); whereas 2.2%, 7.7%, 13.2%, 15.4% and 19.2% for those without ICAS (N=322) (p=0.0001 on log rank test). Crude hazard ratio (HR) of ICAS was 1.9 (95% confidence interval, 1.39 to 2.62), but adjusted HR of ICAS was 1.16 (0.82 to 1.62). The number of intracranial arteries with atherosclerosis and the existence of symptomatic ICAS were also considered. Both of them were significant predictors of the long-term mortality in crude analyses, but lost their significance after adjustments. Conclusions: This study failed to prove the independent contribution of ICAS to the mortality of patients with acute ischemic stroke.