Detrimental Effect of Chronic Hypertension on Leptomeningeal Collateral Flow in Acute Ischemic Stroke
Detrimental Effect of Chronic Hypertension on Leptomeningeal Collateral Flow in Acute Ischemic Stroke
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DOI：
10.1161/strokeaha.119.025142
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发表时间：
2019-07-01
期刊：
影响因子：
8.3
通讯作者：
Toyoda, Kazunori
中科院分区：
文献类型：
--
作者：
Fujita, Kyohei;Tanaka, Kanta;Toyoda, Kazunori
背景和目的-我们的目的是使用数字减影血管造影术评估慢性高血压对大血管缺血性中风患者急性软脑膜侧支血流的影响，这是侧支循环评估的金标准。方法-在2011年10月至2017年12月在我们机构就诊的连续缺血性卒中患者中，入组了经初次数字减影血管造影证实的大脑中动脉M1段急性闭塞患者。慢性高血压定义为指数卒中前的记录或发作前使用抗高血压药物。根据美国介入和治疗神经放射学会/介入放射学会侧支循环分级系统评价血管造影软脑膜侧支循环，并将结果分为优秀（3-4级）或不良（0-2级）侧支循环状态进行分析。结果-在3759例连续缺血性卒中患者中，分析了100例患者。39例患者（39%）的侧支循环状态较差。与侧支循环状态良好的患者相比，侧支循环状态差的患者年龄较大，男性多见，慢性高血压多见，从发病到血管造影的时间较短，入院时收缩压较高。多变量logistic分析显示慢性高血压和不良侧支循环状态之间存在显著正相关（比值比，2.80; 95%CI，1.08-7.70; P=0.034）。这种关联与入院时的收缩压无关。在无慢性高血压患者、病前服用降压药的高血压患者和未服用降压药的高血压患者中，侧支循环状态不良的患者比例呈阶梯式增加（趋势P
Background and Purpose- We aimed to evaluate the effect of chronic hypertension on acute leptomeningeal collateral flow in patients with large-vessel ischemic stroke using digital subtraction angiography, which is the gold standard for the assessment of collateral circulation. Methods- Of the consecutive ischemic stroke patients from October 2011 to December 2017 seen in our institution, patients with acute occlusion of the M1 segment of the middle cerebral artery confirmed on initial digital subtraction angiography were enrolled. Chronic hypertension was defined as its documentation before the index stroke or as the administration of antihypertensive medications before onset. Angiographic leptomeningeal collateral flow was evaluated according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Flow Grading System and dichotomized the findings into excellent (grade 3-4) or poor (grade 0-2) collateral status for analysis. Results- Of the 3759 consecutive ischemic stroke patients, 100 patients were analyzed. Thirty-nine patients (39%) had poor collateral status. Patients with poor collateral status were older, more frequently male, and had chronic hypertension more frequently, shorter time from onset to angiography, and higher admission systolic blood pressure than those with excellent collateral status. Multivariable logistic analysis with prespecified covariates showed a significantly positive association between chronic hypertension and poor collateral status (odds ratio, 2.80; 95% CI, 1.08-7.70; P=0.034). This association was independent of admission systolic blood pressure. The proportion of patients with poor collateral status increased in a stepwise manner in patients without chronic hypertension, hypertensive patients with premorbid antihypertensive medications, and hypertensive patients without antihypertensive medications (P for trend