Collateral flow predicts outcome after basilar artery occlusion: The posterior circulation collateral score
Collateral flow predicts outcome after basilar artery occlusion: The posterior circulation collateral score
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DOI：
10.1177/1747493016641951
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发表时间：
2016-10-01
影响因子：
6.7
通讯作者：
Schonewille, Wouter J.
中科院分区：
文献类型：
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作者：
van der Hoeven, Erik J. R. J.;McVerry, Ferghal;Schonewille, Wouter J.
背景和目的我们的目的是评估基于半定量计算机断层扫描血管造影的分级系统的预后价值，用于预测急性基底动脉闭塞患者的结局，基于计算机断层扫描血管造影上潜在侧支通路的存在：后循环侧支评分（PC-CS）。纳入了来自基底动脉国际合作研究的9例急性基底动脉闭塞患者。我们将一个月时的不良结局（定义为改良兰金量表评分为4或5分）或死亡与侧支血流进行Poisson回归分析。我们使用10分分级系统来量化后交通动脉和小脑动脉中侧支血流的可能性。结果36例患者侧支循环不良（PC-CS：0-3），59例患者侧支循环中度（PC-CS：4-5），54例患者侧支循环良好（PC-CS：6-10）。多变量分析显示，PC-CS良好患者的不良结局风险在统计学上显著低于PC-CS不良患者（风险比（RR）：0. 74，95%置信区间（CI）：0. 58 - 0. 96），但中度PC-CS患者的不良结局风险与PC-CS不良患者相比无统计学意义（RR：0. 95，95% CI：0. 78 - 1. 15）。多因素分析显示，至少存在一个后交通动脉和后交通动脉口径较大的患者预后不良的风险显著降低（RR：0.79，95%CI：0.66-0.95和0.76，95%CI：0.61-0.96）。在一项单独的分析中，后交通动脉的缺失和较小的口径都预示着不良的结局。
Background and Aim Our aim was to assess the prognostic value of a semiquantitative computed tomography angiography-based grading system, for the prediction of outcome in patients with acute basilar artery occlusion, based on the presence of potential collateral pathways on computed tomography angiography: the posterior circulation collateral score (PC-CS).Methods One hundred forty-nine patients with acute basilar artery occlusion from the Basilar Artery International Cooperation Study were included. We related poor outcome at one month, defined as a modified Rankin scale score of 4 or 5, or death to collateral flow with Poisson regression. We used a 10 points grading system to quantify the potential for collateral flow in the posterior communicating arteries and the cerebellar arteries. Additionally, the relation between the presence and size of posterior communicating arteries and outcome was analyzed.Results Thirty-six patients had poor (PC-CS: 0-3), 59 patients intermediate (PC-CS: 4-5), and 54 patients good (PC-CS: 6-10) collaterals. Multivariable analyses showed a statistically significant lower risk of poor outcome in patients with a good PC-CS than in patients with a poor PC-CS (risk ratio (RR): 0.74, 95% confidence interval (CI): 0.58-0.96), but not for patients with an intermediate PC-CS compared with patients with a poor PC-CS (RR: 0.95, 95% CI: 0.78-1.15). Multivariable analyses showed a statistically significant lower risk of poor outcome for the presence of at least one posterior communicating artery and for larger caliber of posterior communicating arteries (RR: 0.79, 95% CI: 0.66-0.95 and 0.76, 95% CI: 0.61-0.96, respectively).Conclusions The PC-CS predicted poor outcome at one month. In a separate analysis, both the absence and smaller caliber of posterior communicating arteries predicted poor outcome.