Sheth Sunil A, Sanossian Nerses, Hao Qing, Starkman Sidney, Ali Latisha K, Kim Doojin, Gonzalez Nestor R, Tateshima Satoshi, Jahan Reza, Duckwiler Gary R, Saver Jeffrey L, Vinuela Fernando, Liebeskind David S
Department of Neurology, University of California Los Angeles, Los Angeles, California, USA.
Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
J Neurointerv Surg. 2016 Jan;8(1):2-7. doi: 10.1136/neurintsurg-2014-011438. Epub 2014 Nov 6.
Endovascular reperfusion techniques are a promising intervention for acute ischemic stroke (AIS). Prior studies have identified markers of initial injury (arrival NIH stroke scale (NIHSS) or infarct volume) as predictive of outcome after these procedures. We sought to define the role of collateral flow at the time of presentation in determining the extent of initial ischemic injury and its influence on final outcome.
Demographic, clinical, laboratory, and radiographic data were prospectively collected on a consecutive cohort of patients who received endovascular therapy for acute cerebral ischemia at a single tertiary referral center from September 2004 to August 2010.
Higher collateral grade as assessed by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading scheme on angiography at the time of presentation was associated with improved reperfusion rates after endovascular intervention, decreased post-procedural hemorrhage, smaller infarcts on presentation and discharge, as well as improved neurological function on arrival to the hospital, discharge, and 90 days later. Patients matched by vessel occlusion, age, and time of onset demonstrated smaller strokes on presentation and better functional and radiographic outcome if found to have superior collateral flow. In multivariate analysis, lower collateral grade independently predicted higher NIHSS on arrival.
Improved collateral flow in patients with AIS undergoing endovascular therapy was associated with improved radiographic and clinical outcomes. Independent of age, vessel occlusion and time, in patients with comparable ischemic burdens, changes in collateral grade alone led to significant differences in initial stroke severity as well as ultimate clinical outcome.
血管内再灌注技术是急性缺血性卒中（AIS）一种很有前景的干预措施。既往研究已确定初始损伤标志物（入院时美国国立卫生研究院卒中量表（NIHSS）评分或梗死体积）可预测这些治疗后的结局。我们试图明确就诊时侧支血流在确定初始缺血性损伤程度及其对最终结局影响方面的作用。
前瞻性收集了2004年9月至2010年8月在一家单一的三级转诊中心接受急性脑缺血血管内治疗的连续队列患者的人口统计学、临床、实验室和影像学数据。
根据美国介入和治疗神经放射学会/介入放射学会（ASITN/SIR）分级方案，就诊时血管造影评估的较高侧支等级与血管内介入治疗后再灌注率提高、术后出血减少、就诊时和出院时梗死灶较小以及入院时、出院时和90天后神经功能改善相关。在血管闭塞、年龄和发病时间相匹配的患者中，如果发现侧支血流较好，则就诊时卒中较小，功能和影像学结局更好。在多变量分析中，较低的侧支等级独立预测入院时较高的NIHSS评分。
接受血管内治疗的AIS患者侧支血流改善与影像学和临床结局改善相关。在缺血负担相当的患者中，独立于年龄、血管闭塞和时间，仅侧支等级的变化就导致初始卒中严重程度以及最终临床结局出现显著差异。
