Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke.
Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke.
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发表时间：
2005-08
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通讯作者：
G. Christoforidis;Y. Mohammad;D. Kehagias;B. Avutu;A. Slivka
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作者：
G. Christoforidis;Y. Mohammad;D. Kehagias;B. Avutu;A. Slivka
背景和目的本研究旨在探讨急性血栓栓塞性卒中期间血管造影所记录的软脑膜侧支形成的解剖学范围与其他预测因素相比，是否可预测动脉内溶栓后的临床结局和梗死体积。方法回顾性分析65例接受溶栓治疗的急性缺血性脑卒中患者的血管造影、CT扫描和临床资料。临床数据包括年龄、性别、治疗时间、美国国立卫生研究院卒中量表（NIHSS）症状评分、出院时NIHSS评分和出院时改良兰金量表评分。通过血管造影确定闭塞部位、溶栓前软脑膜侧支解剖程度评分和再通（完全、部分或无再通）。在治疗后24-48小时进行CT扫描，测量脑体积。结果53例患者（82%）符合审查条件。软脑膜侧支循环评分较好的患者的梗死体积和放电改良兰金量表评分均显著低于软脑膜侧支循环评分较差的患者，无论患者是否完全（P <0.0001）或部分（P = 0.0095）再通。校正其他因素后，回归分析模型显示软脑膜侧支循环评分较差的患者梗死体积明显较大（P <0.0001），出院时改良兰金量表评分和出院时NIHSS评分明显较高。同样，调整其他因素后，完全再通患者的梗死体积显著低于部分再通或无再通患者（P = 0.0006）。结论：溶栓治疗前评估软脑膜侧支形成可以预测接受溶栓治疗的急性脑卒中患者的梗死体积和临床结局，独立于其他预测因素。在软脑膜侧支形成较好的患者中，溶栓治疗似乎具有更大的临床影响。
BACKGROUND AND PURPOSE This study examines whether anatomic extent of pial collateral formation documented on angiography during acute thromboembolic stroke predicts clinical outcome and infarct volume following intra-arterial thrombolysis, compared with other predictive factors. METHODS Angiograms, CT scans, and clinical information were retrospectively reviewed in 65 consecutive patients who underwent thrombolysis for acute ischemic stroke. Clinical data included age, sex, time to treatment, National Institutes of Health Stroke Scale (NIHSS) score on presentation of symptoms, NIHSS score at the time of hospital discharge, and modified Rankin scale score at time of hospital discharge. Site of occlusion, scoring of anatomic extent of pial collaterals before thrombolysis, and recanalization (complete, partial, or no recanalization) were determined on angiography. Infarct volume was measured on CT scans performed 24-48 hours after treatment. RESULTS Fifty-three patients (82%) qualified for review. Both infarct volume and discharge modified Rankin scale scores were significantly lower for patients with better pial collateral scores than those with worse pial collateral scores, regardless of whether they had complete (P < .0001) or partial (P = .0095) recanalization. Adjusting for other factors, regression analysis models indicate that the infarct volume was significantly larger (P < .0001) and modified discharge Rankin scale score and discharge NIHSS score significantly higher for patients with worse pial collateral scores. Similarly, adjusting for other factors, the infarct volume was significantly lower (P = .0006) for patients with complete recanalization than patients with partial or no recanalization. CONCLUSIONS Evaluation of pial collateral formation before thrombolytic treatment can predict infarct volume and clinical outcome for patients with acute stroke undergoing thrombolysis independent of other predictive factors. Thrombolytic treatment appears to have a greater clinical impact in those patients with better pial collateral formation.