Department of Neurology, LMU Munich, Marchioninistr.15, 81377, Munich, Germany.
German Center for Vertigo and Balance Disorders (DSGZ), LMU Munich, Munich, Germany.
J Neurol. 2020 Jul;267(7):2013-2021. doi: 10.1007/s00415-020-09798-0. Epub 2020 Mar 23.
The extent of penumbra tissue and outcome in stroke patients depend on the collateral cranial vasculature. To provide optimal individualized care for stroke patients in the emergency room setting we investigated the predictive capability of a stringent evaluation of the collateral vessels in ischemic stroke on clinical outcome and infarct size.
We retrospectively studied uniform clinical and radiological data of 686 consecutive patients admitted to the emergency department with suspected acute ischemic stroke. Cranial collateral vasculature status was graded using the initial CT-angiography. Outcome was measured by mRS, NIHSS and final infarct size at hospital discharge. All data were used to build a linear regression model to predict the patients´ outcome.
Univariate and multivariate analyses showed significant effects of the whole brain collateral vessel score on all outcome variables. Atherosclerosis and piale collateral status were associated with the final infarct volume (FIV). Atherosclerosis and age were associated with the NIHSS at discharge. The presence of atherosclerosis, glucose level on admission and age were associated with the mRS at discharge. The multivariate models were able to predict 29% of the variance of the mRS at discharge, 24% of the variance in FIV and 17% of the variance of the NIHSS at discharge. The whole brain collateral status and the presence of atherosclerosis were the most relevant predictors for the clinical and radiological outcome.
The whole brain collateral vasculature status is clearly associated with clinical and radiological outcome but in a multivariate model seems not sufficiently predictive for FIV, mRS and NIHSS outcome at discharge in non-preselected patients admitted to the emergency department with ischemic stroke.
脑卒患者的半影组织范围和预后取决于颅外侧支循环血管。为了在急诊环境下为脑卒中患者提供最佳的个体化治疗，我们研究了严格评估缺血性脑卒中患者侧支血管对临床结局和梗死面积的预测能力。
我们回顾性分析了 686 例连续因疑似急性缺血性脑卒中收入急诊的患者的统一临床和影像学数据。使用初始 CT 血管造影评估颅外侧支循环血管状态。采用 mRS、NIHSS 和出院时最终梗死体积评估预后。所有数据均用于构建线性回归模型预测患者的预后。
单因素和多因素分析显示，全脑侧支血管评分对所有预后变量均有显著影响。动脉粥样硬化和软脑膜侧支循环状态与最终梗死体积（FIV）相关。动脉粥样硬化和年龄与出院时 NIHSS 相关。动脉粥样硬化、入院时血糖水平和年龄与出院时 mRS 相关。多变量模型能够预测出院时 mRS 的 29%、FIV 的 24%和 NIHSS 的 17%的方差。全脑侧支状态和动脉粥样硬化的存在是与临床和影像学结局最相关的预测因素。
全脑侧支循环血管状态与临床和影像学结局明显相关，但在多变量模型中，似乎不足以预测非选择性入院的缺血性脑卒中患者出院时的 FIV、mRS 和 NIHSS 结局。
