Lin Michelle P, Tsivgoulis Georgios, Alexandrov Andrei V, Chang Jason J
Department of Neurology, University of Southern California, Los Angeles, CA, USA.
Department of Neurology, University of Athens School of Medicine, Athens, Greece.
Int J Stroke. 2015 Jun;10(4):479-84. doi: 10.1111/ijs.12406. Epub 2014 Dec 3.
Clinical outcome after large-vessel occlusive strokes depends on admitting clinical condition, successful recanalization, and robust collateral circulation. However, predicting successful recanalization and quantifying collateral status in the acute setting remain elusive. Successful recanalization has many predictive factors. Strong evidence supports increasing clot length being associated with poor recanalization. Current imaging techniques completed in the acute setting suggest that clot length can be estimated with a clot burden score. In vitro evidence suggests that clots with more red blood cells and less thrombin lyse more easily after systemic fibrinolysis. Clinical correlations with clot composition have been mixed, although one study suggested that clot composition could be predicted with computed tomography and correlate with successful recanalization. Finally, overwhelming proof shows that robust collateral circulation correlates with improved clinical outcome. Imaging modalities in the acute setting remain promising, with studies suggesting that collaterals can be quantified with computed tomography angiography and perfusion studies. Patients with large-vessel occlusive strokes have variable clinical responses to fibrinolysis and thrombectomy. Independent predictive variables that can possibly alter clinical outcome appear to be successful recanalization and robust collateral circulation. Future studies that allow for better prediction of successful recanalization and quantification of collateral status may help clinical decision-making when evaluating large-vessel occlusions.
大血管闭塞性卒中后的临床结局取决于入院时的临床状况、成功再通以及强大的侧支循环。然而，在急性情况下预测成功再通和量化侧支循环状态仍然困难重重。成功再通有许多预测因素。有力证据支持血栓长度增加与再通不佳相关。在急性情况下完成的当前成像技术表明，可通过血栓负荷评分来估计血栓长度。体外证据表明，红细胞较多且凝血酶较少的血栓在全身纤溶后更容易溶解。尽管有一项研究表明可通过计算机断层扫描预测血栓成分并与成功再通相关，但与血栓成分的临床相关性却好坏参半。最后，确凿证据表明强大的侧支循环与改善的临床结局相关。急性情况下的成像方式仍然很有前景，研究表明可通过计算机断层扫描血管造影和灌注研究来量化侧支循环。大血管闭塞性卒中患者对纤溶和血栓切除术有不同的临床反应。可能改变临床结局的独立预测变量似乎是成功再通和强大的侧支循环。未来能够更好地预测成功再通和量化侧支循环状态的研究可能有助于在评估大血管闭塞时进行临床决策。
