Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino-city, Japan.
Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino-city, Japan.
World Neurosurg. 2019 Aug;128:e660-e663. doi: 10.1016/j.wneu.2019.04.229. Epub 2019 May 3.
No reports have evaluated collateral circulation using simpler measures involving magnetic resonance imaging. Because an anterior communicating artery (A-com) is important in collateral circulation, we investigated whether the presence of an A-com affected the clinical revascularization outcomes in acute ischemic stroke (AIS) in the anterior circulation.
The present retrospective study included 73 patients who had undergone continuous administration of recombinant tissue plasminogen activator and revascularization for AIS in the anterior circulation from April 2014 to September 2018. The presence of an A-com was evaluated using preoperative time-of-flight magnetic resonance angiography. The patient characteristics and clinical outcomes were compared, and we investigated the influence of the presence or absence of an A-com on these clinical outcomes. The clinical outcomes were analyzed using multiple logistic regression.
The clinical outcomes did not significantly correlate with age, sex, or occlusion location but did significantly correlate with the preoperative National Institute of Health stroke scale score, diffusion-weighted Alberta Stroke Program early computed tomography score, reperfusion >50% (thrombolysis in cerebral infarction grade >2b), and onset to recanalization time. The presence of an A-com correlated significantly with good clinical outcomes (modified Rankin scale score 0-3; P = 0.0081) and reduced mortality (P = 0.03). Multiple logistic regression predicted for significantly good clinical outcomes with the presence of an A-com (odds ratio, 17.03; 95% confidence interval, 1.85-157.10; P = 0.012).
The presence of an A-com on preoperative time-of-flight magnetic resonance angiography is a good prognostic factor for revascularization in patients with anterior circulation AIS, confirms collateral circulation, and allows for faster and safer endovascular treatment.
目前尚无研究通过涉及磁共振成像的更简单措施来评估侧支循环。由于前交通动脉（A-com）在侧支循环中很重要，因此我们研究了前循环急性缺血性脑卒中（AIS）中 A-com 的存在是否会影响临床再通结果。
本回顾性研究纳入了 2014 年 4 月至 2018 年 9 月期间接受连续重组组织型纤溶酶原激活剂治疗和前循环再通的 73 例 AIS 患者。使用术前时间飞越磁共振血管造影术评估 A-com 的存在。比较了患者的特征和临床结果，并研究了 A-com 的存在与否对这些临床结果的影响。使用多变量逻辑回归分析临床结果。
临床结果与年龄、性别或闭塞部位无显著相关性，但与术前国立卫生研究院脑卒中量表评分、弥散加权阿尔伯塔卒中计划早期计算机断层扫描评分、再灌注>50%（血栓溶解在脑梗死分级>2b）以及发病至再通时间显著相关。A-com 的存在与良好的临床结果（改良 Rankin 量表评分 0-3；P=0.0081）和降低死亡率（P=0.03）显著相关。多变量逻辑回归预测 A-com 的存在与良好的临床结果显著相关（优势比，17.03；95%置信区间，1.85-157.10；P=0.012）。
术前时间飞越磁共振血管造影术上 A-com 的存在是前循环 AIS 患者再通的良好预后因素，可证实侧支循环的存在，并可进行更快、更安全的血管内治疗。
