Influence of collateral circulation evaluated by CT perfusion imaging in infarction progression and prognoses of patients with acute ischemic stroke before and after thrombectomy
10.3760/cma.j.cn115354-20200802-00621
- VernacularTitle:基于CT灌注成像评估侧支循环在急性缺血性脑卒中取栓前后脑梗死进展及预后评估中的应用
- Author:
Zheyu ZHANG
1
;
Liang'e XU
;
Binze JIANG
;
Sheng ZHANG
;
Zongjie SHI
;
Peng WANG
;
Yu GENG
;
Bin XU
Author Information
1. 浙江中医药大学第二临床医学院，杭州 310053
- Keywords:
Ischemic stroke;
CT perfusion imaging;
Collateral circulation;
Progressive infarct volume;
Prognosis
- From:
Chinese Journal of Neuromedicine
2021;20(1):8-15
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the influence of collateral circulation evaluated by CT perfusion (CTP) imaging in infarction progression and clinical prognoses of patients with acute large-artery occlusion of the anterior circulation before and after thrombectomy.Methods:One hundred and ten patients with acute large-artery occlusion of the anterior circulation within 24 h of onset, admitted to our hospital from May 2018 to September 2019, were chosen in our study; all patients completed thrombectomy; their clinical data were analyzed retrospectively. Regional leptomeningeal collateral-temporally fused maximum intensity projection (rLMC-tMIP) was used to evaluate the collateral circulation based on 4D-CT angiography (4D-CTA). According to the core infarct volume in CTP imaging and the diffusion weighted imaging (DWI) results of MR within one week of surgery, the progressive infarct volume was calculated. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients 3 months after surgery.Results:(1) There were 56 patients with good collateral circulation and 54 patients with poor collateral circulation. Age ( OR=0.951, 95%CI: 0.910-0.993, P=0.023), cardiac dysfunction ( OR=0.116, 95%CI: 0.018-0.731, P=0.022), baseline fasting blood glucose ( OR=0.788, 95%CI: 0.646-0.961, P=0.019), wakefulness stroke ( OR=0.093, 95%CI: 0.023-0.380, P=0.001), and site of vascular occlusion ( OR=7.604, 95%CI: 2.650-21.821, P=0.000) were independent influencing factors for collateral circulation. (2) Scores of rLMC-tMIP ( 95%CI: -2.947- -1.474, P=0.000), volume of ischemic penumbra ( 95%CI: 0.065-0.126, P=0.000), scores of edema in the brain tissues ( 95%CI: 2.952-7.600, P=0.000), hemorrhage transformation ( 95%CI: 8.966-23.114, P=0.000), and 24 h NIHSS scores ( 95%CI: 0.606-1.248, P=0.000) were independent influencing factors for volume of progressive infarction. (3) There were 59 patients having good prognosis and 51 patients having poor prognosis. Hemorrhage transformation ( OR=0.019, 95%CI: 0.001-0.275, P=0.004) and progressive infarction volume ( OR=0.824, 95%CI: 0.756-0.897, P=0.000) were independent influencing factors for prognoses of patients with acute large-artery occlusion of the anterior circulation after thrombectomy. Conclusion:The scores of rLMC-tMIP based on 4D-CTA can well predict the infarction volume in patients with acute large-artery occlusion of the anterior circulation within 24 h of onset, which can effctively evaluate the clinical prognoses of the patients.
