ＰＥＴにより評価した脳主幹動脈閉塞症の脳循環動態と長期予後
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In major cerebral arterial occlusive diseases, patients with increased oxygen extraction fraction (OEF), which is measured with positron emission tomography (PET), may be at increased risk for cerebral ischemia. The purpose of the first study was to determine whether increased OEF is a predictor of long-term risk of subsequent stroke. We prospectively evaluated the relationship between the regional hemodynamic status of cerebral circulation and the subsequent risk of stroke in 40 patients with symptomatic internal carotid artery (ICA) or middle cerebral artery occlusive diseases who underwent PET. Patients were divided into 2 hemodynamic categories according to the mean hemispheric value of OEF in the hemisphere supplied by the artery with symptomatic disease: patients with increased OEF and those with normal OEF.All patients were followed for 5 years with medical treatment until death or the recurrence of stroke. During 5 years, 11 strokes, 9 of which were ipsilateral ischemic, occurred. Five of 7 patients with increased OEF had ischemic strokes, and 6 of 33 patients with normal OEF had ischemic strokes. There were 4 ipsilateral ischemic strokes in patients with increased OEF and 5 in those with normal OEF. Kaplan-Meier analysis revealed that the risks of all stroke and ipsilateral ischemic stroke in patients with increased OEF were significantly higher than in those with normal OEF (log-rank test; p<0.0002 and p<0.0018, respectively). Multivariate analysis with the Cox proportional hazards model demonstrated that increased OEF significantly increased stroke recurrence: the relative risk was 7.2 (95% confidence interval [CI], 2.0-25.5; p<0.005) for all stroke and 6.4 (95% CI, 1.6-26.1; p<0.01) for ipsilateral stroke. These findings suggest that an increased OEF is an independent predictor of 5-year risk of subsequent stroke.The purpose of the second study was to determine whether in patients with ICA occlusion and initially normal OEF, subsequent deterioration of cerebral hemodynamics occurs during long-term follow-up and, if so, whether the increase of the OEF is associated with subsequent ischemic stroke. We used PET to serially evaluate 7 medically treated patients with unilateral ICA occlusion and initially normal OEF at intervals ranging from 24 to 64 months. No intervening ischemic attacks occurred between the 2 examinations. In the hemisphere with ICA occlusion, the OEF increased and the blood flow decreased during follow-up. At the follow-up evaluation, 3 patients showed an abnormally increased OEF value. In all patients with increased OEF, subsequent ipsilateral ischemic strokes occurred, whereas none of those who still showed normal OEF had a subsequent stroke. In patients with ICA occlusion and initially normal OEF, subsequent deterioration of cerebral hemodynamics occurred. The increase of the OEF was associated with subsequent ischemic stroke.Evaluation of the changes in cerebral hemodynamics may be useful for identifying patients in whom the risk for ischemic stroke increases during long-term follow-up. Identification of patients with increased OEF may have clinical significance in preventing recurrent stroke.
- 一般社団法人 日本脳卒中の外科学会の論文
一般社団法人 日本脳卒中の外科学会 | 論文
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