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背景:华法令-阿司匹林治疗症状性颅内动脉疾病比较研究(WASID)最近评价了颅内动脉狭窄溶栓治疗的疗效。WASID研究的主要目的是明确颅内动脉狭窄区域发生脑卒中的高危因素,为随后开展的颅内动脉支架植入及内科治疗比较研究奠定基础。方法及结果:WASID是一项随机、双盲、多中心研究,共入选569例TIA或缺血性脑卒中患者,这些患者的主要颅内动脉狭窄程度均在50％-99％。发生事件到入选研究的平均时间为17天,平均随访时间为1．8 年。采用多因素Cox比例风险模型分析与动脉狭窄区域脑卒中发生相关的危险因素。结果106例患者发生缺血性脑卒中,占19．0％;其中77例发生在狭窄动脉供应区域,占73%。颅内动脉狭窄发生脑卒中的危险因素依次为动脉狭窄超过≥70％,(风险比率:2．03,95％ CI:1．29-3．22,P=0．0025),发生事件至入选时间在17天以内,(风险比率:1．69,95％ CI:1．06-2．72,P=0．028)。尽管统计学差异处于临界值,(风险比率: 1．59．95％ CI:1．00-2．55,P=0．051),但女性发病的危险性也相应增加。动脉狭窄的部位、事件的类型及是否预先服用抗栓药物与脑卒中的发生风险均无相关性。结论:症状性颅内动脉狭窄发生脑卒中的危险因素有动脉狭窄超过70％、近期发生过TIA或缺血性脑卒中及女性。
Background: Warfarin-Aspirin in the Treatment of Symptomatic Intracranial Artery Disease (WASID) recently evaluated the efficacy of intracranial arterial stenosis thrombolysis. The main purpose of WASID study is to identify the high risk factors for stroke in the area of intracranial arterial stenosis, which lays a foundation for the subsequent comparative study of intracranial artery stenting and medical treatment. Methods and Results: WASID is a randomized, double-blind, multicenter study of 569 TIA or ischemic stroke patients with major intracranial stenoses ranging from 50% to 99%. The average time to incident study was 17 days with an average follow-up of 1.8 years. Risk factors associated with stroke in areas with arterial stenosis were analyzed using a multivariate Cox proportional hazard model. Results 106 cases of ischemic stroke occurred, accounting for 19.0%; of which 77 cases occurred in the narrow artery supply area, accounting for 73%. Risk factors for stroke with intracranial arterial stenosis were, in turn, ≥70% of arterial stenoses (hazard ratio: 2.03, 95% CI: 1.29-3.22, P = 0.0025), event to enrolling Time was within 17 days (hazard ratio: 1.69, 95% CI: 1.06-2.72, P = 0.028). Although the statistical difference was at a critical level (hazard ratio: 1.59.95% CI: 1.00-2.55, P = 0.051), the risk of developing women was also correspondingly increased. There was no correlation between the location of arterial stenosis, the type of event, and the presence or absence of antithrombotic drugs in advance and the risk of stroke. CONCLUSIONS: Stroke risk factors for symptomatic intracranial arterial stenosis include arterial stenosis in excess of 70%, and recent episodes of TIA or ischemic stroke and women.