Interventional Neuroradiology, West Virginia University Health Sciences Center, Morgantown, WV 26506-9235, USA.
Cardiovasc Intervent Radiol. 2012 Dec;35(6):1332-9. doi: 10.1007/s00270-011-0323-7. Epub 2011 Dec 14.
To identify factors impacting outcome in patients undergoing interventions for acute ischemic stroke (AIS).
This was a retrospective analysis of patients undergoing endovascular therapy for AIS secondary during a 30 month period. Outcome was based on modified Rankin score at 3- to 6-month follow-up. Recanalization was defined as Thrombolysis in myocardial infarction score 2 to 3. Collaterals were graded based on pial circulation from the anterior cerebral artery either from an ipsilateral injection in cases of middle cerebral artery (MCA) occlusion or contralateral injection for internal carotid artery terminus (ICA) occlusion as follows: no collaterals (grade 0), some collaterals with retrograde opacification of the distal MCA territory (grade 1), and good collaterals with filling of the proximal MCA (M2) branches or retrograde opacification up to the occlusion site (grade 2). Occlusion site was divided into group 1 (ICA), group 2 (MCA with or without contiguous M2 involvement), and group 3 (isolated M2 or M3 branch occlusion).
A total of 89 patients were studied. Median age and National Institutes of health stroke scale (NIHSS) score was 71 and 15 years, respectively. Favorable outcome was seen in 49.4% of patients and mortality in 25.8% of patients. Younger age (P = 0.006), lower baseline NIHSS score (P = 0.001), successful recanalization (P < 0.0001), collateral support (P = 0.0008), distal occlusion (P = 0.001), and shorter procedure duration (P = 0.01) were associated with a favorable outcome. Factors affecting successful recanalization included younger age (P = 0.01), lower baseline NIHSS score (P = 0.05), collateral support (P = 0.01), and shorter procedure duration (P = 0.03). An ICA terminus occlusion (P < 0.0001), lack of collaterals (P = 0.0003), and unsuccessful recanalization (P = 0.005) were significantly associated with mortality.
Angiographic findings and preprocedure variables can help prognosticate procedure outcomes in patients undergoing endovascular therapy for AIS.
确定影响急性缺血性脑卒中（AIS）患者介入治疗结果的因素。
这是一项回顾性分析，纳入了 30 个月期间接受血管内治疗的 AIS 患者。以 3-6 个月随访时的改良 Rankin 评分来评估预后。再通定义为血栓溶栓评分 2-3 分。根据大脑前动脉的软脑膜循环，将侧支循环分级，对于大脑中动脉（MCA）闭塞，同侧注射时分为无侧支循环（0 级）、有逆行显影的一些侧支循环（1 级）和有良好侧支循环、近端 MCA（M2）分支显影或逆行显影至闭塞部位（2 级）；对于颈内动脉终末段闭塞，对侧注射时分为无侧支循环（0 级）、有逆行显影的一些侧支循环（1 级）和良好侧支循环、近端 MCA 显影（2 级）。闭塞部位分为 1 组（ICA）、2 组（MCA 伴或不伴连续 M2 受累）和 3 组（孤立的 M2 或 M3 分支闭塞）。
共纳入 89 例患者。中位年龄和美国国立卫生研究院卒中量表（NIHSS）评分为 71 岁和 15 分。49.4%的患者预后良好，25.8%的患者死亡。年龄较小（P=0.006）、基线 NIHSS 评分较低（P=0.001）、再通成功（P<0.0001）、侧支循环支持（P=0.0008）、远端闭塞（P=0.001）和手术时间较短（P=0.01）与预后良好相关。影响再通成功的因素包括年龄较小（P=0.01）、基线 NIHSS 评分较低（P=0.05）、侧支循环支持（P=0.01）和手术时间较短（P=0.03）。颈内动脉终末段闭塞（P<0.0001）、无侧支循环（P=0.0003）和再通失败（P=0.005）与死亡率显著相关。
血管造影表现和术前变量有助于预测接受 AIS 血管内治疗患者的治疗结果。
