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Прогнозирование риска развития повторного инсульта после перенесенной транзиторной ишемической атаки у пациентов с очагом инфаркта по данными МРТ и без такового
Резюме. По данным различных авторов риск развития повторного инсульта после перенесенной транзиторной ишемической атаки (ТИА) в первые 3 мес колеблется от 15 до 20%. Поэтому совершенствование мер вторичной профилактики развития инсульта после ТИА является важным и актуальным. В то же время исследованию различных аспектов этой клинической формы цереброваскулярной патологии уделяется недостаточное внимание. Остается невыясненным вопрос о степени риска и частоты развития инсульта после перенесенной ТИА с новым очагом ишемии по данным нейровизуализации и без такого. Цель исследования — прогнозирование риска и частоты развития повторного инсульта после перенесенной ТИА с новым очагом ишемии по данным магнитно- резонансной томографии (МРТ) и без такового у больных с различными патогенетическими подтипами заболевания. Обследованы 103 пациента с атеротромботическим, кардиоэмболическим, лакунарным, гемодинамическим подтипом ТИА. По результатам нейровизуализации все пациенты были разделены на 2 группы: ТИА с поражением ткани головного мозга и ТИА без признаков такого поражения. Определена частота выявления новых очагов ишемии у больных с различными патогенетическими подтипами ТИА. Проспективная оценка 2-летнего исследования риска инсульта показала, что наиболее часто повторный инсульт развивался после перенесенной ТИА с очагом ишемии (относительный риск = 5,28 , 95% доверительный интервал = 2,4–8,7). Определена вероятность развития инсульта в зависимости от патогенетического подтипа ТИА. Описаны особенности развития повторного инсульта и его частота у пациентов с ТИА с новым очагом по данным нейровизуализации и без такового при различных патогенетических подтипах ТИА.
Ключевые слова: транзиторные ишемические атаки, патогенетический подтип, прогнозирование, нейровизуализация, риск возникновения инсульта, диагностика.
Prediction of risk of recurrent stroke after transient ischemic attack in patients with and without infarction on MRI
Summary. According to different authors the risk of recurrent stroke after transient ischemic attack (TIA) in the first three months ranged from 15 to 20%. Therefore, the improvement of secondary prevention of stroke after TIA is important and relevant. At the same time, insufficient attention is given to the study of various aspects of this clinical form of cerebrovascular pathology. It remains unclear the extent of the risk and frequency of stroke after TIA with and without a new foci of ischemia according to the neurovisualization. The main aim of our re- search is the prediction of risk and fre- quency of recurrent stroke after TIA subject to the presence or absence of a new foci of ischemia on magnetic resonance imaging (MRI) in patients with different pathoge- netic subtypes of the disease. We examined 103 patients with aterothrombotic, cardi- oembolic, lacunar, hemodynamic subtypes of TIA. As a result, all the patients were di- vided into 2 groups: TIA with or without foci of ischemia on MRI. Frequency of a new foci of ischemia in patients with different patho- genetic subtypes of TIAs was determined. Prospective estimation of the 2-year risk of stroke showed that most frequently recur- rent stroke developed after TIA with a new foci of ischemia (relative risk = 5.28 (95% confidence interval = 2.4–8.7). The probabil- ity of stroke depending on the pathogenetic subtype of TIA was defined. The features and frequency of the recurrent stroke in patients with TIA with or without a new foci of ischemia on MRI are described in a variety of patho- genetic subtypes of TIAs.
Key words: transient ischemic attack, pathogenetic subtype, prediction, neurovisualization, risk of stroke, diagnostics.