Department of Neurology, Seoul National University Hospital, Seoul, South Korea.
Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea.
Eur J Neurol. 2017 Sep;24(9):1148-1155. doi: 10.1111/ene.13351. Epub 2017 Jul 14.
Although a stroke from atherosclerosis in the basilar artery (BA) often presents with mild initial stroke severity, it has heterogeneous clinical courses. We investigated the efficacy of digital subtraction angiography (DSA)-based collateral perfusion evaluation in association with long-term outcomes of medically treated symptomatic basilar artery stenosis.
From a registry database of all consecutive patients with stroke, we included 98 medically treated patients (due to mild initial stroke severity) [National Institute of Health Stroke Scale (NIHSS) scores ≤ 4; symptomatic basilar artery stenosis, 70-99%] with available initial diagnostic DSA. Basilar collateral scoring was performed via the DSA, using a modified version of the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology grading system in both the superior cerebellar artery and anterior/posterior-inferior cerebellar artery territories (score 0-8). The outcomes were designated as the 90-day modified Rankin Scale (mRS90) score (poor, 3-6). Student's t-test, chi-square test and logistic regression analyses were used to identify factors associated with a poor outcome.
The median initial NIHSS score was 2 [interquartile range (IQR), 0-3], median posterior circulation Alberta Stroke Program Early CT Score was 8 (IQR, 7-10), median collateral score was 7 (IQR, 7-8) and 20 (20.4%) had poor mRS90 scores. In multivariate analysis, poorer collateral scores (P = 0.003), higher NIHSS scores (P = 0.005) and lower posterior circulation Alberta Stroke Program Early CT Score (P = 0.017) were independently associated with a poor mRS90 score.
The DSA-based collateral scoring of the BA large branches might predict long-term outcome in medically treated symptomatic basilar artery stenosis with mild initial severity. Evaluation of BA collateral perfusion status might be useful to determine appropriate treatment strategies.
尽管基底动脉（BA）的动脉粥样硬化性卒中初始严重程度通常较轻，但它具有异质性的临床病程。我们研究了基于数字减影血管造影（DSA）的侧支灌注评估与经药物治疗的有症状基底动脉狭窄的长期预后之间的关系。
我们从所有连续的卒中患者的注册数据库中，纳入了 98 例经药物治疗的患者（由于初始卒中严重程度较轻[NIHSS 评分≤4；症状性基底动脉狭窄，70-99%]），这些患者具有初始诊断性 DSA 检查的可用资料。通过 DSA 进行基底动脉侧支评分，使用改良的美国介入治疗神经放射学会/介入放射学会分级系统对小脑上动脉和前后/小脑后下动脉区域的侧支进行评分（0-8 分）。结局定义为 90 天改良 Rankin 量表（mRS90）评分（不良，3-6 分）。使用学生 t 检验、卡方检验和逻辑回归分析来确定与不良结局相关的因素。
中位初始 NIHSS 评分为 2 分（四分位距[IQR]，0-3 分），中位后循环 Alberta 卒中项目早期 CT 评分 8 分（IQR，7-10 分），中位侧支评分 7 分（IQR，7-8 分），20 例（20.4%）患者 mRS90 评分不良。多变量分析显示，较差的侧支评分（P = 0.003）、较高的 NIHSS 评分（P = 0.005）和较低的后循环 Alberta 卒中项目早期 CT 评分（P = 0.017）与不良的 mRS90 评分独立相关。
基于 DSA 的基底动脉大分支侧支评分可能预测经药物治疗的初始严重程度较轻的有症状基底动脉狭窄的长期预后。评估基底动脉侧支灌注状态可能有助于确定适当的治疗策略。
