侧支循环水平对急性前循环大血管闭塞行机械取栓治疗预后的影响

目的探讨侧支循环水平对急性前循环大血管闭塞患者机械取栓治疗预后的影响。方法回顾性分析2015年9月—2020年6月120例行机械取栓的急性前循环大血管闭塞病例的影像及临床资料,首先依据侧支循环水平不同分为侧支循环较好组(n=63)和侧支循环较差组(n=57),比较两组机械取栓治疗前、术后24 h、术后1周及术后1个月美国国立卫生研究院卒中量表(NIHSS)评分,以及术后神经功能改善情况、术后90 d改良Rankin量表(mRS)评分、症状性颅内出血发生率及病死率。将mRS评分为0~2分视为预后良好组(n=74),3~6分视为预后较差组(n=46),对影响预后的因素进行多因素Logistic回归分析。结果术后24 h、术后1周及术后1个月,两组NIHSS评分均较治疗前显著降低,且侧支循环较好组均低于侧支循环较差组(P<0.05,P<0.01)。侧支循环较差组术后神经功能恢复情况及90 d良好预后率低于侧支循环较好组,病死率和症状性颅内出血发生率高于侧支循环较好组(P<0.05)。多因素Logistic回归分析结果显示,术后24 h NIHSS评分较高与侧支循环水平较差是影响急性前循环大血管闭塞行机械取栓预后的独立危险因素(P<0.05,P<0.01)。结论颅内侧支循环水平在一定程度上决定急性前循环大血管闭塞机械取栓治疗的预后,较好的侧支循环是取得良好预后的重要条件。

Effect of Collateral Circulation Level on Prognosis of Patients with Acute Anterior Circulation Large Vessel Occlusion Undergoing Mechanical Thrombectomy

Objective To investigate effect of collateral circulation level on the prognosis of patients with acute anterior circulation large vessel occlusion(LVO)undergoing mechanical thrombectomy.Methods Imaging and clinical data of 120 patients with acute anterior circulation LVO who had undergone mechanical thrombectomy during September 2015 and June 2020 was retrospectively analyzed.The patients were divided into good collateral circulation group(n=63)and poor collateral circulation group(n=57)according to different collateral circulation levels.National Institutes of Health Stroke Scale(NIHSS)scores before and at 24 h,the 1 st week and the 1 st month after mechanical thrombectomy,postoperative condition of neurological improvement,modified Rankin Scale(mRS)score at the 90 th d after operation,incidence rate of symptomatic intracranial hemorrhage(sICH)and mortality were compared between two groups.Patients with mRS score of 0 to 2 score were regarded as good prognosis group(n=74),and patients with score of 3 to 6 score were regarded as poor prognosis group(n=46),and multivariate logistic regression analysis was performed for factors affecting prognosis.Results NIHSS scores at 24 h,the 1 st week and the 1 st month after mechanical thrombectomy were significantly decreased compared with those before treatment in two groups,and the scores were lower in good collateral circulation group than those in poor collateral circulation group(P<0.05,P<0.01).In poor collateral circulation group,postoperative condition of neurological recovery and good prognosis rate at the 90 th-d were lower,while mortality and incidence rate of symptomatic intracranial hemorrhage(sICH)were higher than those in good collateral circulation group(P<0.05).Multivariate logistic regression analysis showed that higher NIHSS score at 24 h after mechanical thrombectomy and poor collateral circulation level were independent risk factors affecting prognoses of patients with acute anterior circulation LVO undergoing mechanical thrombectomy(P<0.05,P<0.01).Conclusion The level of intracranial collateral circulation determines prognosis of patients with acute anterior circulation LVO undergoing mechanical thrombectomy in a certain extent,and good collateral circulation is an important condition for patients to achieve good prognosis.