Liu Feifeng, Chen Chen, Hong Lan, Shen Hao, Cao Wenjie, Dong Qiang, Yang Xinyi, Guo Mengruo, Li Ying, Xiao Yaping, Cheng Xin, Li Gang
Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, China.
Department of Neurology, Shanghai huashan hospital, Fudan University, Shanghai, China.
BMC Neurol. 2020 Apr 16;20(1):139. doi: 10.1186/s12883-020-01716-1.
Endovascular therapy is widely used in acute large vessel occlusion. This study investigated whether imaging of lateral lenticulostriate arteries (LSAs) before thrombectomy would potentially be helpful for predicting prognosis of patients with acute M1 segment of middle cerebral artery occlusion (MCAO).
59 consecutive patients with acute M1 segment of MCAO treated with mechanical thrombectomy at two comprehensive stroke centers were analyzed. Patients were categorized into LSA+ (appearing of lateral LSAs) and LSA- (sparing of lateral LSAs) group according to preprocedural digital substraction angiography (DSA). Baseline data and clinical outcomes were compared. A good clinical outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The association between clinical and imaging parameters and functional outcome was evaluated with logistic regression analysis.
LSA+ was shown in 36 patients (61%). LSA+ group had a significantly higher proportion of good outcome (72.2% vs. 8.7%, OR 27.3,95% CI 5.38-138.4, P < 0.001), lower risk of symptomatic intracranial haemorrhages (sICH) (8.3% vs. 47.8%,OR 0.10,95% CI 0.02-0.42, P = 0.001) and lower mortality in hospital (5.6% vs. 34.8%, OR 0.11,95% CI 0.02-0.58, P < 0.004) compared with LSA- group. Patients in LSA+ group had lower baseline NIHSS score(P < 0.01) and NIHSS score at 14 days(P < 0.01) and smaller infarct core volume (P = 0.016) on computed tomography perfusion imaging (CTP) compared to the LSA- group. Multivariate logistic regression analysis showed that a small infarct core volume (OR 6.74,95% CI 1.148-39.569, P = 0.035) and LSA+(OR 22.114,95% CI 3.339-146.470, P = 0.001) were associated with a good clinical outcome.
Our data suggest that appearance of lateral LSAs before mechanical thrombectomy would be potentially helpful for predicting favorable prognosis of patients with acute M1 segment of MCAO.
血管内治疗广泛应用于急性大血管闭塞。本研究调查了在血栓切除术前行外侧豆纹动脉（LSA）成像是否可能有助于预测大脑中动脉M1段急性闭塞（MCAO）患者的预后。
分析了在两个综合卒中中心接受机械血栓切除术治疗的59例连续性急性MCAO-M1段患者。根据术前数字减影血管造影（DSA）将患者分为LSA+组（外侧LSA显影）和LSA-组（外侧LSA未显影）。比较基线数据和临床结局。良好的临床结局定义为3个月时改良Rankin量表评分为0至2分。采用逻辑回归分析评估临床和影像参数与功能结局之间的关联。
36例患者（61%）显示为LSA+。与LSA-组相比，LSA+组良好结局的比例显著更高（72.2%对8.7%，OR 27.3，95%CI 5.38-138.4，P<0.001），症状性颅内出血（sICH）风险更低（8.3%对47.8%，OR 0.10，95%CI 0.02-0.42，P=0.001），住院死亡率更低（5.6%对34.8%，OR 0.11，95%CI 0.02-0.58，P<0.004）。与LSA-组相比，LSA+组患者在计算机断层扫描灌注成像（CTP）上的基线美国国立卫生研究院卒中量表（NIHSS）评分更低（P<0.01）、14天时的NIHSS评分更低（P<（此处原文有误，应是P<0.01））以及梗死核心体积更小（P=0.016）。多因素逻辑回归分析显示，梗死核心体积小（OR 6.74，95%CI 1.148-39.569，P=0.035）和LSA+（OR 22.114，95%CI 3.339-146.470，P=0.001）与良好的临床结局相关。
我们的数据表明，在机械血栓切除术前行外侧LSA显影可能有助于预测急性MCAO-M1段患者的良好预后。
