The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long-term functional outcome in stroke patients with large vessel intracranial occlusion.
The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long-term functional outcome in stroke patients with large vessel intracranial occlusion.
复制标题
DOI：
10.1161/strokeaha.110.592303
复制
发表时间：
2010-10
期刊：
影响因子：
8.3
通讯作者：
Nogueira RG
中科院分区：
文献类型：
--
作者：
Lima FO;Furie KL;Silva GS;Lev MH;Camargo EC;Singhal AB;Harris GJ;Halpern EF;Koroshetz WJ;Smith WS;Yoo AJ;Nogueira RG
非侵入性方法在侧支循环评估中的作用尚未确定。我们假设，通过计算机断层扫描血管造影（CTA）确定的软脑膜侧支循环的有利模式与改善的结局相关。分析了来自两家大学医院的前瞻性队列研究的数据，这些医院在缺血性卒中急性期系统性地进行了CTA。选择颅内颈内动脉（伊卡）和/或大脑中动脉（MCA-M1或M2段）完全闭塞的患者。软脑膜侧支循环模式被分级为3类有序变量（小于、等于或大于未受影响的对侧半球）。进行单变量和多变量分析，以确定6个月时良好结局的独立预测因素（mRS≤2）。196例患者入选。平均年龄为69 ±17岁，中位NIHSS评分为13（IQR 6-17）。在单变量分析中，年龄、基线NIHSS、卒中前mRS、ASPECT评分、入院血糖、高血压病史、冠状动脉疾病、充血性心力衰竭、房颤、闭塞部位和侧支循环模式是结局的预测因素。在多变量分析中，年龄（OR 0.95; 95%CI [0.93-0.98]，p=0.001），基线NIHSS（OR 0.75; [0.69-0.83]，p<0.001），卒中前mRS（OR 0.41; [0.22-0.76]，p=0.01），静脉注射r-tPA（OR 4.92; [1.83-13.25]，p=0.01），糖尿病（OR 0.31; [0.01-0.98]，p=0.046）和软脑膜侧支循环（OR 1.93; [1.06-3.34]，p=0.03）被确定为良好结局的独立预测因素。与血管造影研究一致，CTA上的软脑膜侧支循环也是缺血性卒中良好结局的可靠标志。
The role of non-invasive methods in the evaluation of collateral circulation has yet to be defined. We hypothesized that a favorable pattern of leptomeningeal collaterals, as identified by computed tomography angiography (CTA), correlates with improved outcomes. Data from a prospective cohort study at two university based hospitals where CTA was systematically performed in the acute phase of ischemic stroke were analyzed. Patients with complete occlusion of the intracranial internal carotid artery (ICA) and/or the middle cerebral artery (MCA-M1 or M2 segments) were selected. Leptomeningeal collateral pattern was graded as a three category ordinal variable (less, equal, or greater than the unaffected contralateral hemisphere). Univariate and multivariate analyses were performed to define the independent predictors of good outcome at 6 months (mRS≤2). 196 patients were selected. The mean age was 69 ±17 years and the median NIHSS score was 13 (IQR 6-17). In the univariate analysis, age, baseline NIHSS, pre-stroke mRS, ASPECT score, admission blood glucose, history of hypertension, coronary artery disease, congestive heart failure, atrial fibrillation, site of occlusion, and collateral pattern were predictors of outcome. In the multivariate analysis, age (OR 0.95; 95%CI [0.93-0.98], p=0.001), baseline NIHSS (OR 0.75; [0.69-0.83], p<0.001), pre-stroke mRS (OR 0.41; [0.22-0.76], p=0.01), intravenous r-tPA (OR 4.92; [1.83-13.25], p=0.01), diabetes( OR 0.31; [0.01-0.98], p=0.046) and leptomeningeal collaterals (OR 1.93; [1.06-3.34], p=0.03) were identified as independent predictors of good outcome. Consistent with angiographic studies, leptomeningeal collaterals on CTA are also a reliable marker of good outcome in ischemic stroke.