Chen Wang, Song Xiaojie, Tian Dachen, Sun Hongyang, Zhang Lijun, Hui Xin, Ip Bonaventure Ym, Wang Xianjun
Department of Neurology, People's Hospital of Linyi, The Eleventh Clinical Medical College of Qingdao University, Linyi, Shandong, China.
Department of Neurology, People's Hospital of Linyi, Linyi, Shandong, China.
Heliyon. 2019 Apr 8;5(4):e01476. doi: 10.1016/j.heliyon.2019.e01476. eCollection 2019 Apr.
Despite successful recanalization, there remain many patients suffering bad outcome after endovascular treatment, especially for occlusion at the distal portion of internal carotid artery. The goal of the current study was to investigate the value of collateral circulation in predicting malignant events after endovascular treatment in acute ischemic stroke-terminal internal carotid artery (AIS-TICA) patients.
The records of forty-one patients with AIS-TICA as confirmed by digital subtraction angiography and subjected to mechanical thrombectomy were reviewed. On the basis of the collateral circulation grading system (ACG) from the American Society of Interventional and Therapeutic Neuroradiology/American Society of Interventional Radiology (ASITN/SIR), class of leptomeningeal compensation were evaluated as grade 0 to 4. Factors for malignant events were evaluated by retrospectively univariate analysis. Moreover, analysis of correlation was performed between collateral circulation and malignant events. Malignant events were defined as a malignant middle cerebral artery infarction or parenchymal hemorrhage 2.
Of the 41 subjects, 13 (31.71%) had postoperative malignant events. Though 36 (87.80%) of the patients had a complete recanalization, only 17 patients (41.46%) showed good outcomes with modified Rankin score≤2 at 3 months. 9 (21.95%) deaths occurred in the hospital. Besides, patients in the malignant group had significantly higher scores on the National Institute of Health stroke scale (P = 0.032) and lower anterior circulation compensation (P = 0.000). Furthermore, correlation analysis showed that probability of malignant events was negatively correlated with anterior circulation compensation (r = -0.534, P = 0.000).
The leptomeningeal compensation of anterior circulation can be predicted whether a malignant event will occur after endovascular treatment in AIS-TICA patients. The probability of malignant events is significantly increased if the anterior circulation collateral compensation score is 0-1.
尽管血管再通成功，但血管内治疗后仍有许多患者预后不良，尤其是颈内动脉远端闭塞的患者。本研究的目的是探讨侧支循环在预测急性缺血性卒中-颈内动脉末端（AIS-TICA）患者血管内治疗后不良事件中的价值。
回顾了41例经数字减影血管造影证实为AIS-TICA并接受机械取栓治疗的患者的记录。根据美国介入和治疗神经放射学会/美国介入放射学会（ASITN/SIR）的侧支循环分级系统（ACG），将软脑膜代偿等级评估为0至4级。通过回顾性单因素分析评估不良事件的相关因素。此外，对侧支循环与不良事件之间进行相关性分析。不良事件定义为恶性大脑中动脉梗死或脑实质出血2。
41例患者中，13例（31.71%）术后发生不良事件。尽管36例（87.80%）患者实现了完全再通，但只有17例患者（41.46%）在3个月时改良Rankin评分≤2，显示出良好的预后。9例（21.95%）患者在医院死亡。此外，不良事件组患者的美国国立卫生研究院卒中量表评分显著更高（P = 0.032），前循环代偿更低（P = 0.000）。此外，相关性分析表明，不良事件的发生概率与前循环代偿呈负相关（r = -0.534，P = 0.000）。
前循环的软脑膜代偿情况可预测AIS-TICA患者血管内治疗后是否会发生不良事件。如果前循环侧支代偿评分为0-1分，不良事件的发生概率会显著增加。
