近日一项研究显示，在颈动脉支架置入术（CAS）后，磁共振弥散加权成像（DWI）发现的缺血性脑损伤似乎是预测复发性脑血管事件发生危险增加的标志物。有围手术期DWI脑损伤的患者在CAS后或可从更积极和延长的抗血小板治疗中获益。

　　既往的研究表明，在CAS后的DWI检查中经常发现脑损伤，但有关其临床相关性仍不清楚。这项随机、对照试验旨在研究CAS或颈动脉内膜切除术（CEA）后，围手术期DWI发现的缺血性脑损伤是否与复发性脑血管事件发生危险增加相关。研究纳入ICSS磁共振成像（MRI）亚组研究中231例有症状的颈动脉狭窄患者，并将他们随机分为CAS组（124例）和CEA组（107例）。患者在治疗前以及治疗后1~3天接受MRI检查。主要转归事件是发生在治疗后MRI检查和随访结束之间任何区域的卒中或短暂性脑缺血发作（TIA）。在治疗后MRI检查时，分别对CAS和CEA组有新发脑损伤（DWI+）和无新发脑损伤（DWI-）患者的至发生主要转归事件的时间进行比较。

　　结果显示，中位随访4.1年期间，CAS组DWI+患者的复发性卒中或TIA发生率高于DWI-患者（12/62对比6/62），累计5年发生率分别为22.8%和8.8%（校正后的HR:2.85，P= 0.04）。在治疗后6个月内，DWI+和DWI-患者分别发生了8个和2个事件。在CEA组，DWI+和DWI-患者间的复发性脑血管事件无显著差异。

（英文原文）Ischemic Brain Lesions After Carotid Artery StentingIncrease Future Cerebrovascular Risk

　　BackgroundBrain lesions on diffusion-weighted imaging (DWI) arefrequently found after carotid artery stenting (CAS), but their clinicalrelevance remains unclear.

　　ObjectivesThis study sought to investigate whether periproceduralischemic DWI lesions after CAS or carotid endarterectomy (CEA) are associatedwith an increased risk of recurrent cerebrovascular events.

　　Methods In the magnetic resonance imaging (MRI) substudy of ICSS(International Carotid Stenting Study), 231 patients with symptomatic carotidstenosis were randomized to undergo CAS (n = 124) or CEA (n = 107).MRIs were performed 1 to 7 days before and 1 to 3 days after treatment. Theprimary outcome event was stroke or transient ischemic attack in any territoryoccurring between the post-treatment MRI and the end of follow-up. Time tooccurrence of the primary outcome event was compared between patients with(DWI+) and without (DWI–) new DWI lesions on the post-treatment scan in the CASand CEA groups separately.

　　ResultsMedian time of follow-up was 4.1 years (interquartilerange: 3.0 to 5.2). In the CAS group, recurrent stroke or transient ischemicattack occurred more often among DWI+ patients (12 of 62) than among DWI–patients (6 of 62), with a cumulative 5-year incidence of 22.8% (standard error[SE]: 7.1%) and 8.8% (SE: 3.8%), respectively (unadjusted hazard ratio: 2.85;95% confidence interval: 1.05 to 7.72; p = 0.04). In DWI+ and DWI–patients, 8 and 2 events, respectively, occurred within 6 months aftertreatment. In the CEA group, there was no difference in recurrentcerebrovascular events between DWI+ and DWI– patients.

　　ConclusionsIschemic brain lesionsdiscovered on DWI after CAS seem to be a marker of increased risk for recurrentcerebrovascular events. Patients with periprocedural DWI lesions might benefitfrom more aggressive and prolonged antiplatelet therapy after CAS. (ARandomised Comparison of the Risks, Benefits and Cost Effectiveness of PrimaryCarotid Stenting With Carotid Endarterectomy: International Carotid StentingStudy; ISRCTN25337470)

　　来源：CardioSource Journal scans（February 9，2015）