Friedrich Benjamin, Kempf Felix, Boeckh-Behrens Tobias, Fischer Johanna, Lehm Manuel, Bernd Maria, Wunderlich Silke, Mönch Sebastian, Zimmer Claus, Maegerlein Christian
Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany.
Arnold Sommerfeld Center for Theoretical Physics, Department of Physics, LMU Munich, Munich, Germany.
Cardiovasc Intervent Radiol. 2018 Dec;41(12):1917-1924. doi: 10.1007/s00270-018-2029-6. Epub 2018 Jul 10.
In patients with acute occlusions of the middle cerebral artery, the collaterals play an important role in infarct growth and potentially on clinical outcome. As the primary collateral pathway, the posterior cerebral artery with the posterior communicating artery (PComA) is important. We analyzed the influence of the presence of an ipsilateral PComA on infarct growth and clinical outcome.
We included 101 patients with M1 occlusions and subsequent endovascular treatment and differentiated patients without an ipsilateral PComA from those with an ipsilateral PComA.
There was no difference in the rate of successful recanalizations and procedural parameters between both groups. Of the patients with an existing PComA, 51% showed an excellent clinical outcome (90d mRS < 2), but only 28% of the patients without PComA had an excellent clinical outcome (p = 0.02). The presence of an ipsilateral PComA was independently associated with the rate of excellent clinical outcome (aOR 3.9, 95% CI 1.2-9.8; p = 0.021) and lower infarct volume (38 ± 8 cm vs. 78 ± 13 cm, p = 0.032).
The presence of an ipsilateral PComA is a predictor for excellent clinical outcome independently from the technical success of mechanical recanalization. This finding provides insights into the changes of circulation in patients suffering from an acute stroke and underlines the importance of collateralization.
在大脑中动脉急性闭塞患者中，侧支循环在梗死灶扩大以及潜在的临床结局方面发挥着重要作用。作为主要的侧支循环途径，大脑后动脉与后交通动脉（PComA）的组合很重要。我们分析了同侧PComA的存在对梗死灶扩大和临床结局的影响。
我们纳入了101例M1段闭塞并接受后续血管内治疗的患者，并将无同侧PComA的患者与有同侧PComA的患者区分开来。
两组之间成功再通率和手术参数没有差异。在有PComA的患者中，51%的患者临床结局良好（90天改良Rankin量表评分<2），但无PComA的患者中只有28%临床结局良好（p = 0.02）。同侧PComA的存在与良好临床结局率独立相关（调整后比值比3.9，95%置信区间1.2 - 9.8；p = 0.021），且梗死体积较小（38±8 cm³对78±13 cm³，p = 0.032）。
同侧PComA的存在是良好临床结局的一个预测指标，独立于机械再通的技术成功与否。这一发现为急性中风患者的循环变化提供了见解，并强调了侧支循环的重要性。
