Mangiafico Salvatore, Consoli Arturo, Renieri Leonardo, Rosi Andrea, De Renzis Alioscia, Vignoli Chiara, Capaccioli Leonardo
Ital J Anat Embryol. 2013;118(3):277-87.
The imaging of ischemic penumbra in acute stroke is a debated issue and establishing commonly accepted criteria is difficult. Computerized tomography-perfusion studies conducted in animals have showed that the modifications occurring in the brain parenchima are part of a dynamic and progressive process involving the microcirculation. The purpose of this paper is to propose a new angiographic classification of collateral circulation in patients with acute ischemic stroke, with a possible correlation with the clinical outcome.
The basal angiograms of 57 patients with acute ischemic stroke is the territory of anterior circulation secondary to a major occlusion, who underwent endovascular treatment, were retrospectively reviewed and collaterals were classified according to our novel Careggi Collateral Score in 6 grades (0-6). The clinical outcome after 3 months was evaluated with modified Rankin Scale. A ROC (receiver operating characteristic) curve analysis identified a cut-off value of 1.
Patients with favorable collateral circulation (grades 2-5) showed a significant correlation with good clinical outcome (modified Rankin Scale < or = 2).
The Careggi Collateral Score resulted a useful tool to evaluate the chance of obtaining a favorable result with endovascular treatment in patients with acute ischemic stroke in the anterior circulation secondary to the occlusion of a major artery.
急性卒中缺血半暗带的影像学检查是一个存在争议的问题，建立普遍认可的标准很困难。在动物身上进行的计算机断层扫描灌注研究表明，脑实质中发生的改变是涉及微循环的动态渐进过程的一部分。本文的目的是提出一种急性缺血性卒中患者侧支循环的新血管造影分类方法，并探讨其与临床结局的可能相关性。
回顾性分析57例因主要血管闭塞继发前循环区域急性缺血性卒中且接受血管内治疗患者的基础血管造影图像，根据我们新的卡雷吉侧支循环评分将侧支循环分为6个等级（0 - 6级）。采用改良Rankin量表评估3个月后的临床结局。通过ROC（受试者工作特征）曲线分析确定临界值为1。
侧支循环良好（2 - 5级）的患者与良好的临床结局（改良Rankin量表评分≤2）显著相关。
卡雷吉侧支循环评分是评估因主要动脉闭塞继发前循环急性缺血性卒中患者接受血管内治疗获得良好结局可能性的有用工具。
