From the Department of Neuroradiology of Pierre Wertheimer Hospital, Hospices Civils de Lyon, France (O.F.E., Y.B.).
Department of Neurology and Comprehensive Stroke Center (L.R., T.-H.C., L.M., L.D., E.O., N.N.).
Stroke. 2019 Jun;50(6):1582-1585. doi: 10.1161/STROKEAHA.119.025608. Epub 2019 Apr 30.
Background and Purpose- The development of leptomeningeal collateral artery network might be adversely affected by small vessel wall alteration. We sought to determine whether small vessel disease (SVD) burden may impact collateral development in patients treated by mechanical thrombectomy for anterior circulation acute ischemic stroke. Methods- The patients admitted in our center for anterior circulation acute ischemic stroke and (1) treated by mechanical thrombectomy with or without thrombolysis and (2) who underwent a baseline magnetic resonance imaging were included in the study. The SVD burden and the pial collaterality were assessed through the cerebral SVD score (severe when ≥1) and the Higashida score (favorable when ≥ 3) on magnetic resonance imaging and digital subtraction angiography, respectively. Any association between the cerebral SVD score and the collaterality were assessed through comparative and regression analyses. Results- Between January 2013 and March 2018, 240 patients met the inclusion criteria (68.7±16.1 years old; 49.2 % female). The cerebral SVD scores were of 0 in 125 (52.1%), 1 in 74 (30.8%), 2 in 30 (12.5%), and 3 in 11 (4.6%) patients. Hundred and thirty-six patients (58.1%) presented a favorable collaterality score. The favorable collaterality subgroup presented a significantly higher proportion of female (79%), lower baseline National Institutes of Health Stroke Scale ( P<0.001), and higher Diffusion-Weighted Imaging-Alberta Stroke Program Early CT Scores ( P<0.001). The regression analyses showed no impact of the cerebral SVD score on the collaterality pattern (odds ratio, 1.11, 95% CI, 0.82-1.50; P=0.51). Conclusions- In patients with anterior circulation acute ischemic stroke, collateral flow status does not seem to be influenced by SVD burden.
背景与目的- 软脑膜侧支动脉网络的发展可能会受到小血管壁改变的不利影响。我们旨在确定小血管疾病（SVD）负担是否会影响接受机械血栓切除术治疗的前循环急性缺血性脑卒中患者的侧支发育。方法- 纳入在我院就诊的前循环急性缺血性脑卒中患者，（1）接受机械血栓切除术治疗（无论是否溶栓），（2）基线行磁共振成像检查。SVD 负担和软脑膜侧支循环通过磁共振成像上的脑 SVD 评分（严重程度≥1）和数字减影血管造影上的 Higashida 评分（良好程度≥3）进行评估。通过比较和回归分析评估脑 SVD 评分与侧支循环之间的任何关联。结果- 2013 年 1 月至 2018 年 3 月，符合纳入标准的患者共 240 例（68.7±16.1 岁；49.2%为女性）。脑 SVD 评分为 0 的患者有 125 例（52.1%），评分为 1 的患者有 74 例（30.8%），评分为 2 的患者有 30 例（12.5%），评分为 3 的患者有 11 例（4.6%）。136 例（58.1%）患者侧支循环评分良好。侧支循环良好亚组中女性比例显著更高（79%），基线国立卫生研究院卒中量表评分更低（P<0.001），弥散加权成像-阿尔伯塔卒中计划早期 CT 评分更高（P<0.001）。回归分析显示，脑 SVD 评分对侧支循环模式无影响（比值比，1.11，95%CI，0.82-1.50；P=0.51）。结论- 在接受机械血栓切除术治疗的前循环急性缺血性脑卒中患者中，侧支血流状态似乎不受 SVD 负担的影响。
