颅内椎基底动脉粥样硬化狭窄卒中机制的特点OA

Objective Patients with intracranial vertebrobasilar atherosclerotic stenosis(IVBAS)face a high risk of stroke recurrence,and clarifying the mechanism of stroke is crucial for secondary prevention.This study aims to investi-gate the characteristics of stroke mechanisms in patients with IVBAS.Methods This study was conducted at a national-level stroke center in 2013-2019.The patients who were hospitalized due to severe IVBAS(≥70%)were enrolled.Based on the characteristics of lesions on diffusion-weighted imaging,stroke mechanisms were classified into three types of artery-to-artery(A-A)embolism,perforating artery occlusion,and mixed mechanism.Related data were collected and as-sessed,including risk factors,use of antiplatelet drugs,location of lesion,and stroke recurrence.Results Among the 395 patients enrolled in this study,227(57.5%)had A-A embolism,83(21.0%)had perforating artery occlusion,and 85(21.5%)had a mixed mechanism.Most patients with perforating artery occlusion had lesions located in the basilar ar-tery(68.7%),while A-A embolism was more common in the vertebral artery(63.0%).Although the mixed mechanism group had a slightly higher recurrence rate,the difference was not statistically significant.A-A embolism had the highest incidence rate of 51.4%as the initial mechanism among the patients with A-A embolism,and perforating artery occlusion had the highest incidence rate of 77.8%as the initial mechanism among the patients with perforating artery occlusion.There was a significant correlation between the initial stroke mechanism and the recurrent stroke mechanism.For patients with a mixed mechanism,comparable incidence rates were observed for A-A embolism(31.3%),perforating artery occlu-sion(37.4%),and mixed mechanism(31.3%).Conclusion A-A embolism is most likely the most common stroke mechanism in patients with IVBAS.There might be a certain difference in the incidence rates of lesion locations involved in patients with different stroke mechanisms.The recurrent stroke mechanism is closely associated with the initial stroke mechanism.