Clinical prognosis analysis of collateral circulation and vascular recanalization in patients with acute ischemic stroke based on multiphase CTA
10.3760/cma.j.issn.1671-0282.2019.12.005
- VernacularTitle: 基于多时相CTA评估急性缺血性脑卒中的侧支循环与静脉溶栓治疗后的临床预后分析
- Author:
Wei WANG
1
;
Xianqun RAO
1
;
Chao YUAN
1
;
Yao WANG
1
;
Bin HE
1
;
Qianghui LIU
1
;
Xiaoquan XU
2
;
Gao MA
2
;
Kai SUN
1
Author Information
1. Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
2. Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Publication Type:Journal Article
- Keywords:
Retrospective studies;
Acute ischemic stroke;
Intravenous thrombolysis;
Multiphase CT angiography;
Collateral circulation
- From:
Chinese Journal of Emergency Medicine
2019;28(12):1485-1489
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the relationship between the status of collateral circulation provided by multiphase CT angiography and the benefit and risk of vascular recanalization in patients with middle cerebral artery (MCA) occlusion.
Methods:This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University from October 2017 to September 2018. According to the ASPECTS collateral circulation score, the patients were divided into two groups: good collateral group (n=31) and poor collateral group (n=18). The benefits and risks after thrombolysis in the two groups were compared, including 24-h NIHSS score, 30-day mortality, 90-day modified rankin scale (mRS) score, and the incidence of symptomatic cerebral hemorrhage. Statistical analysis was performed using t test, corrected χ2 test, or Fisher's exact test.
Results:The 24-h NIHSS score and 90-day mRS score in the good collateral group were significantly lower than those in the poor collateral group (4.6±5.6 vs 12.5±8.4, P=0.00; 1.7±1.7 vs 3.1±1.5, P<0.05). The incidence of NIHSS score improved by ≥50% and the incidence of 90-day mRS 0-2 was significantly higher in the good collateral group after 24 h of thrombolysis (77.4% vs 27.8%, P<0.05; 80.6% vs 27.8%, P=0.00); The incidence of symptomatic cerebral hemorrhage was significantly lower in the good collateral group than in the poor group (9.7% vs 50.0%, P<0.05). There was no significant difference in mortality between the two groups after 30 days of thrombolysis (P>0.05), but the 30-day mortality of the poor collateral group was still greater than that of the good collateral group (11.1% vs 0%).
Conclusion:For patients with acute MCA infarction and receiving vascular recanalization therapy, patients with good collateral circulation can achieve good clinical outcomes, restore better recent neurological function, and obtain lower incidence of symptomatic cerebral hemorrhage and lower disability and mortality rate.
