Stroke Unit, Department of Neurology (A.G.-T., M. Rubiera, M. Requena, M.M., J.P., D.R.-L, M.D., J.J., N.R.-V., S.B., M.O.-G., E.S., J.A.-S., C.A.M., M. Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
Stroke Unit, Neurology Unit, Department of Neuroscience, Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Italy (L.C.).
Stroke. 2021 Jan;52(1):299-303. doi: 10.1161/STROKEAHA.120.031338. Epub 2020 Nov 30.
We aim to evaluate if good collateral flow (CF) modifies endovascular therapy (EVT) efficacy on large-vessel stroke. To do that, we used final degree of reperfusion and number of device-passes performed, factors previously associated with better functional outcome, as main outcome measures.
Single-center retrospective study including consecutive stroke patients receiving EVT for anterior circulation large-vessel stroke. CF degree was assessed on CT angiography before EVT using a previously validated 4-grade score. Final degree of reperfusion, using modified Thrombolysis in Cerebral Ischemia (mTICI), and number of device-passes performed were prospectively collected. Multivariable analysis was performed to evaluate the influence of collateral flow degree on final degree of reperfusion and number of device-passes performed.
Six hundred twenty-six patients were included in the study; 369 patients (59%) presented good collateral flow on CT angiography. Five hundred twenty-two patients (84%) achieved successful reperfusion (mTICI 2B-3) after EVT, 304 (48%) of them with a final mTICI 2C-3. Median number of device-passes was 2 (interquartile range, 1-3). Good CF was independently associated with better final degree of reperfusion (shift analysis for mTICI0-2A/2B/2C-3%, poor CF 19/38/43 versus good CF 15/32/53, adjusted odds ratio, 1.51 [95% CI, 1.08-2.11]). Poor CF was independently associated with higher number of device-passes performed to achieve successful reperfusion (mTICI2B-3; shift analysis for 1/2/3/4+ device-passes, adjusted odds ratio, 1.59, [95% CI, 1.09-2.31]) and complete reperfusion (mTICI2C-3; shift analysis for 1/2/3/4+ device-passes, adjusted odds ratio, 1.70 [95% CI, 1.04-2.90]).
Patients with good CF treated with EVT experience higher rates of successful reperfusion with lower number of device-passes. CF may facilitate thrombus retrieval and prevent distal embolization of clot fragments, improving device-passes efficacy.
我们旨在评估良好的侧支循环（CF）是否会改变大血管卒中的血管内治疗（EVT）效果。为此，我们使用最终的再灌注程度和使用的器械通过次数作为主要结果测量指标，这两个因素先前与更好的功能结果相关。
这项单中心回顾性研究纳入了连续接受 EVT 治疗的前循环大血管卒中患者。在 EVT 前，使用之前验证的 4 级评分，通过 CT 血管造影评估 CF 程度。前瞻性收集最终的再灌注程度（采用改良脑梗死溶栓（mTICI））和使用的器械通过次数。进行多变量分析以评估 CF 程度对最终再灌注程度和使用的器械通过次数的影响。
共纳入 626 例患者；369 例（59%）患者在 CT 血管造影上显示良好的侧支循环。522 例（84%）患者在 EVT 后实现了成功再灌注（mTICI 2B-3），其中 304 例（48%）患者最终达到 mTICI 2C-3。器械通过次数的中位数为 2 次（四分位距 1-3 次）。良好的 CF 与更好的最终再灌注程度独立相关（mTICI0-2A/2B/2C-3%的较差 CF 为 19/38/43%，而良好 CF 为 15/32/53%，调整后的优势比为 1.51[95%可信区间，1.08-2.11]）。较差的 CF 与实现成功再灌注所需的器械通过次数增加独立相关（mTICI2B-3；1/2/3/4+器械通过次数的移位分析，调整后的优势比为 1.59[95%可信区间，1.09-2.31]）和完全再灌注（mTICI2C-3；1/2/3/4+器械通过次数的移位分析，调整后的优势比为 1.70[95%可信区间，1.04-2.90]）。
接受 EVT 治疗的 CF 良好的患者成功再灌注率更高，所需的器械通过次数更少。CF 可能有助于血栓的清除，并防止血栓碎片的远端栓塞，从而提高器械通过的效果。
