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Etiyolojik Faktör Olarak Non-Valvuler Atriyal Fibrilasyon Saptanan İnme Hastalarında Beyin Damar Alanlarının İncelenmesi

Yıl 2018, Cilt: 5 Sayı: 2, 14 - 18, 01.08.2018

Öz

Bu çalışmada; non-valvuler atriyal fibrilasyon (NVAF) etyolojisine sahip inme hastalarında serebral vasküler bölgeleri araştırmak amaçlandı. Ocak 2015-Eylül 2016 tarihleri arasında hastanemize başvuran ve 55 yaşın üzerinde olan, tıbbi öykülerinde standart EKG veya Holter EKG kaydı bulunan veya NVAF tanısı konan ve iskemik serebrovaskuler hastalık teşhisi alan 208 hasta çalışmaya dahil edildi. Çalışmamız retrospektif verilerin bir analizi olarak tasarlanmıştır. Hastaların ayrıntılı öykü, fizik muayene ve elektrokardiyografi (EKG) değerlendirmeleri yapıldı. Bulguların tespitinde tanımlayıcı istatistikler kullanılmış ve t-testi, Pearson ki-kare ve Fisher'in kesin testi, farklılıklar analizi için kullanılmıştır. Hastaların %53.8'i (n=112) erkek, %46.2'si (n=96) kadındı. Yaş ortalaması 73.5 idi. Orta serebral arter (MCA), NVAF'ye bağlı inmelerde en sık vasküler tutulum alanıydı. Superior serebellar arter (SCA) ve posterior serebral arter (PCA), MCA'yı takip etti. NVAF ile ilişkili inmelerin yaklaşık %64'ü ön sirkülasyon enfarktüsü (ACI) ve %22'si arka sirkülasyon enfarktüsü (PCI) idi. Yaş ve geçmiş inme öyküsü faktörlerinde ACI lehine anlamlı bir fark vardı (p <0.05). Hipertansiyon, kardiyak öykü ve diabetüs mellitüs faktörlerinde ACI ve PCI arasında anlamlı fark yoktu (p> 0.05). Sonuç olarak, akut olarak ortaya çıkan enfarktlarda iskemiye uğrayan damar alanının ve bu damar alanı için etiyolojik faktörün tahmin edilebileceği vurgulanmıştır.

Kaynakça

  • 1. Chung JW, Park SH, Kim N, et al. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification and vascular territory of ischemic stroke lesions diagnosed by diffusion-weighted imaging. J Am Heart Assoc. 2014;3(4):1–8.
  • 2. Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation. Circulation 2006;114(7):e257-e354.
  • 3. Tatu L, Moulin T, Vuillier F, Bogousslavsky J. Arterial territories of the human brain. Manifest Stroke. 2012;30:99–110.
  • 4. Gladstone DJ, Spring, M, Dorian P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Eng J Med. 2014;370(26):2467–77.
  • 5. Bogousslavsky J, Van Melle G, Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 1988;19:1083–92.
  • 6. Moulin T, Tatu L, Crépin-Leblond T, Chavot D, Bergès S, Rumbach L. The Besancon Stroke Registry: An acute stroke registry of 2,500 consecutive patients. Eur Neurol. 1997;38(1):10–20.
  • 7. Rovira A, Grive E, Alvarez-Sabin J. Distribution territories and causative mechanisms of ischemic stroke. Eur Radiol. 2005;5(3):416–26.
  • 8. Stecco A, Quagliozzi M, Soligo E, et al. Can neuroimaging differentiate PFO and AF-related cardioembolic stroke from the other embolic sources? Clinical-radiological correlation on a retrospective study. La radiologia medica. 2017;22(6):412–8.
  • 9. Paciaroni M, Silvestrelli G, Caso V, et al. Neurovascular territory involved in different etiological subtypes of ischemic stroke in the Perugia Stroke Registry. Eur Neurol. 2003; 10(4):361–5.
  • 10. 1Anderson DC, Kappelle LJ, Eliasziw M, Babikian VL, Pearce LA, Barnett HJM. Occurrence of hemispheric and retinal ischemia in atrial fibrillation compared with carotid stenosis. Stroke. 2002;33:1963.
  • 11. Harrison MJ, Marshall J. Atrial fibrillation, TIAs and completed strokes. Stroke 1984;15:441.
  • 12. Ezekowitz MD, James KE, Nazarian SM, et al. Silent cerebral infarction in patients with nonrheumatic atrial fibrillation. The Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. Circulation. 1995;92:2178.
  • 13. Demir S, Ozdag MF, Kendirli MT, Togrol RE. What do anticoagulants say about microemboli? J Stroke Cerebrovasc Dis. 2015;4(11):2474–7.
  • 14. Lin HJ, Wolf PA, Kelly-Hayes M, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760.
  • 15. Lamassa M, Di Carlo A, Pracucci G, et al. Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe: data from a multicenter multinational hospital-based registry (The European Community Stroke Project). Stroke 2001;32(2):392.
  • 16. Cohen AT, Hamilton M, Mitchell SA, et al. Comparison of the novel oral anticoagulants apixaban, dabigatran, edoxaban, and rivaroxaban in the initial and long-term treatment and prevention of venous thromboembolism: systematic review and network meta-analysis. PLoS One. 2015;10(12):e0144856
  • 17. Bogousslavsky J, Regli F. Anterior cerebral artery territory infarction in the Lausanne Stroke Registry: clinical and etiologic patterns. Arch Neurol. 1990;47(2):144-50.

Investigation of Brain Vascular Territories in Stroke Patients Detected Non-Valvular Atrial Fibrillation as an Etiological Factor

Yıl 2018, Cilt: 5 Sayı: 2, 14 - 18, 01.08.2018

Öz

It was aimed to investigate the cerebral vascular territories in stroke patients with NVAF as an etiologic factor. A total of 208 patients who were referred to our hospital between January 2015 and September 2016, who were over 55 years of age, identified or documented as having a standard ECG or Holter ECG record on their medical history, and diagnosed with stroke were included. Our study was designed as a retrospective analysis of prospective data. Detailed history, physical examination and electrocardiography (ECG) evaluations of the patients were performed. Descriptive statistics were used in the detection of findings, and t-test, Pearson’s chi-square and Fisher's exact test were used for differences analysis. 53.8% (n=112) of the patients were male and 46.2% (n=96) were female. The mean age was 73.5. MCA was the most common site of vascular involvement in NVAF-dependent strokes. SCA and PCA followed MCA. Approximately 64% of the NVAF-related strokes were anterior circulation infarction (ACI) and 22% were posterior circulation infarct (PCI). There was a significant difference in age and past stroke history factors in favor of ASE (p < 0.05). There was no significant difference between ACI and PCI in hypertension, cardiac history and diabetus mellitus factors (p > 0.05). It was emphasized that the area of the vessel that underwent ischemia in the acutely displayed infarcts and the etiological factor for this vessel area could be predicted.

Kaynakça

  • 1. Chung JW, Park SH, Kim N, et al. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification and vascular territory of ischemic stroke lesions diagnosed by diffusion-weighted imaging. J Am Heart Assoc. 2014;3(4):1–8.
  • 2. Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation. Circulation 2006;114(7):e257-e354.
  • 3. Tatu L, Moulin T, Vuillier F, Bogousslavsky J. Arterial territories of the human brain. Manifest Stroke. 2012;30:99–110.
  • 4. Gladstone DJ, Spring, M, Dorian P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Eng J Med. 2014;370(26):2467–77.
  • 5. Bogousslavsky J, Van Melle G, Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 1988;19:1083–92.
  • 6. Moulin T, Tatu L, Crépin-Leblond T, Chavot D, Bergès S, Rumbach L. The Besancon Stroke Registry: An acute stroke registry of 2,500 consecutive patients. Eur Neurol. 1997;38(1):10–20.
  • 7. Rovira A, Grive E, Alvarez-Sabin J. Distribution territories and causative mechanisms of ischemic stroke. Eur Radiol. 2005;5(3):416–26.
  • 8. Stecco A, Quagliozzi M, Soligo E, et al. Can neuroimaging differentiate PFO and AF-related cardioembolic stroke from the other embolic sources? Clinical-radiological correlation on a retrospective study. La radiologia medica. 2017;22(6):412–8.
  • 9. Paciaroni M, Silvestrelli G, Caso V, et al. Neurovascular territory involved in different etiological subtypes of ischemic stroke in the Perugia Stroke Registry. Eur Neurol. 2003; 10(4):361–5.
  • 10. 1Anderson DC, Kappelle LJ, Eliasziw M, Babikian VL, Pearce LA, Barnett HJM. Occurrence of hemispheric and retinal ischemia in atrial fibrillation compared with carotid stenosis. Stroke. 2002;33:1963.
  • 11. Harrison MJ, Marshall J. Atrial fibrillation, TIAs and completed strokes. Stroke 1984;15:441.
  • 12. Ezekowitz MD, James KE, Nazarian SM, et al. Silent cerebral infarction in patients with nonrheumatic atrial fibrillation. The Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. Circulation. 1995;92:2178.
  • 13. Demir S, Ozdag MF, Kendirli MT, Togrol RE. What do anticoagulants say about microemboli? J Stroke Cerebrovasc Dis. 2015;4(11):2474–7.
  • 14. Lin HJ, Wolf PA, Kelly-Hayes M, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760.
  • 15. Lamassa M, Di Carlo A, Pracucci G, et al. Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe: data from a multicenter multinational hospital-based registry (The European Community Stroke Project). Stroke 2001;32(2):392.
  • 16. Cohen AT, Hamilton M, Mitchell SA, et al. Comparison of the novel oral anticoagulants apixaban, dabigatran, edoxaban, and rivaroxaban in the initial and long-term treatment and prevention of venous thromboembolism: systematic review and network meta-analysis. PLoS One. 2015;10(12):e0144856
  • 17. Bogousslavsky J, Regli F. Anterior cerebral artery territory infarction in the Lausanne Stroke Registry: clinical and etiologic patterns. Arch Neurol. 1990;47(2):144-50.
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular İç Hastalıkları
Bölüm Araştırma Makalesi
Yazarlar

Serkan Demir

Mustafa Karaoglan Bu kişi benim

Yayımlanma Tarihi 1 Ağustos 2018
Gönderilme Tarihi 30 Temmuz 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 5 Sayı: 2

Kaynak Göster

APA Demir, S., & Karaoglan, M. (2018). Investigation of Brain Vascular Territories in Stroke Patients Detected Non-Valvular Atrial Fibrillation as an Etiological Factor. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, 5(2), 14-18.
AMA Demir S, Karaoglan M. Investigation of Brain Vascular Territories in Stroke Patients Detected Non-Valvular Atrial Fibrillation as an Etiological Factor. MMJ. Ağustos 2018;5(2):14-18.
Chicago Demir, Serkan, ve Mustafa Karaoglan. “Investigation of Brain Vascular Territories in Stroke Patients Detected Non-Valvular Atrial Fibrillation As an Etiological Factor”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 5, sy. 2 (Ağustos 2018): 14-18.
EndNote Demir S, Karaoglan M (01 Ağustos 2018) Investigation of Brain Vascular Territories in Stroke Patients Detected Non-Valvular Atrial Fibrillation as an Etiological Factor. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 5 2 14–18.
IEEE S. Demir ve M. Karaoglan, “Investigation of Brain Vascular Territories in Stroke Patients Detected Non-Valvular Atrial Fibrillation as an Etiological Factor”, MMJ, c. 5, sy. 2, ss. 14–18, 2018.
ISNAD Demir, Serkan - Karaoglan, Mustafa. “Investigation of Brain Vascular Territories in Stroke Patients Detected Non-Valvular Atrial Fibrillation As an Etiological Factor”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 5/2 (Ağustos 2018), 14-18.
JAMA Demir S, Karaoglan M. Investigation of Brain Vascular Territories in Stroke Patients Detected Non-Valvular Atrial Fibrillation as an Etiological Factor. MMJ. 2018;5:14–18.
MLA Demir, Serkan ve Mustafa Karaoglan. “Investigation of Brain Vascular Territories in Stroke Patients Detected Non-Valvular Atrial Fibrillation As an Etiological Factor”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, c. 5, sy. 2, 2018, ss. 14-18.
Vancouver Demir S, Karaoglan M. Investigation of Brain Vascular Territories in Stroke Patients Detected Non-Valvular Atrial Fibrillation as an Etiological Factor. MMJ. 2018;5(2):14-8.